Newsletter2008 02 by The Network: TUFH

THE NETWORK TOWARDS UNITY FOR HEALTH

VOLUME 27 | NUMBER 02 | DECEMBER 2008

NEWSLETTER

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IN THIS ISSUE, AMONG OTHERS: No Teachers or Students, Just Participants 06

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Soft Skills Training in Malaysia 13

Consortium for Longitudinal Integrated Curricula 16

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Oral Health Promotion in South Africa 21 Experiences in the Eastern Mediterranean Region 24

to everybody from the Network: TUFH office

Marion Stijnen and Pauline Vluggen Editors

12 08 In the Newsletter we refer to The Network: Towards Unity for Health as The Network: TUFH.

CONTENTS 03 Foreword Primary Healthcare: Now More than Ever 04 The Network: TUFH in Action 04 Annual International Conference “This Group Represents a Support System like No Other” | Winning Posters | Jumping into the Deep for a Trial by Fire | Bogotá Briefing on Primary Healthcare | No Teachers or Students, Just Participants | The 2009 Conference 07 Book Review Awakening Hippocrates 08 Position Paper Review Position Paper on Interprofessional Education and Practice 09 International Health Professions Education 09 Leadership Column Creating a New Style of Medical Doctor 10 Problem-Based Learning and Community-Based Education Enhancing Medical Education and Scholarship in Uganda 11 New Institutions and Programmes Last Year of the Maastricht Medical Curriculum: HELP and SCIP 12 Yellow Papers Attitudes towards Computer Education in Medical Curriculum | Soft Skills Training in Malaysia 14 Social Accountability Pajarito Mesa: How a ‘Little Bird’ Took Flight 15 The Like-Minded Working Together Global Health Education Consortium 16 Medical Education Consortium for Longitudinal Integrated Curricula | JMHPE: Third Group of Graduates 17 Improving Health 17 Health Authorities What Would I Change if I Were Minister of Health? | Health Reform in Colombia 19 Women’s Health Preventing Paediatric HIV in Rural South Africa 20 Indigenous Health Traditional Medicine Mapped 21 Health Promotion Oral Health Promotion in South Africa 22 Students’ Column 22 Out of the SNO Pen How to Become an Effective Leader of Change 22 Students’ Speakers Corne Welcome Back Kenya 23 Student Interview The Big Five 24 Member and Organisational News 24 About our Members Experiences in the Eastern Mediterranean Region | Re-Assessing Full Members | New Members | Interesting Internet Sites | Family Medicine and Primary Healthcare in Africa 27 Taskforces Interprofessional Education Taskforce: An Update | Taskforce Care for the Elderly Gets New Chair | Introducing the Taskforce Social Accountability and Accreditation 29 Represented at International Meetings/Conferences Expanding Horizons in Medical Education 30 Introducing Members Northern Ontario School of Medicine 31 International Diary Diary 2009 32 About our Members Tribute to... | Moving On: Changes in Institutional Leadership

FOREWORD

Primary Healthcare: Now More than Ever The importance of the 2008 World Health Report is that primary healthcare will remain on the medico-political agenda for the foreseeable future. PHC advocacy will continue to expand in the shaping of healthcare under local conditions in communities around the world. It should be very clear: advocacy is not to forward interests of PHC professionals, but the health of communities and people. Dr. Jan de Maeseneer

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For The Network: TUFH, the 2008 World Health Report is an invitation to refocus on the need to make undergraduate training of health workers more socially accountable

Reference VAN WEEL, C., DE MAESENEER, J., & RICHARDS, R. (2008). Integration of personal and community health care. The Lancet, 372:871-2. Lancet RAWAF, S., DE MAESENEER, J., & STARFIELD, B. (2008). From Alma-Ata to Almaty: A new start for primary health care. The Lancet Lancet, 372:1365-1367.

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It will be critical to forward a better understanding of why PHC is effective. Close ties between the World Organisation of Family Doctors (Wonca) and university departments of PHC and family medicine are vital to its successful performance. An important issue is to acknowledge the core professionals in the field, in particular family physicians and nurses. Until now, the professional background of primary care professionals has been defined in deliberately broad and vague terms, but recommendations of teaching and training remain void, unless it is specified whom to address.

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Another difference, compared to 30 years ago, is that today evidence is available on the effects of PHC. The holistic touch of the personal doctor and care provider has an impact that reaches beyond the costs of interventions, and it is a major determinant of population’s health, together with the improvement of daily living conditions and the tackling of the inequitable distribution of power, money and resources. The report Closing the gap in a generation: Health equity through action on the social determinants of health of the Commission of Social Determinants of Health illustrates the outcomes: (http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf tions/2008/9789241563703_eng.pdf).

Dr. Chris van Weel

A world-wide global plan for primary healthcare is needed, and the WHO should set the agenda for this development by creating a specific high-level unit for primary healthcare that cuts across the programme-oriented vertical diseases in the organisation (Rawaf et al., 2008). Primary healthcare: Now more than ever sets ambitious challenges for primary healthcare. Now, in contrast to 1978, we know more about how to meet these challenges. Let Wonca and The Network: TUFH contribute and co-operate to meet the challenges.

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Thirty years ago, at the city of Alma-Ata, the WHO declaration on primary healthcare was th published. On October the 14 2008 at Almaty, the actual name of Alma-Ata, the new WHO World Health Report was launched. Probably the most significant progress that has been made in primary healthcare (PHC) in the past decades is the international unity in concepts and core values that underlie PHC: care directed at the determinants of health that matter (‘community-oriented’), aiming to promote and preserve health as much as possible and restore it when needed (‘patient- or person-centeredness), and built on a personal professional relationship between patient and doctor over time (‘continuity of care’) (Van Weel et al., 2008).

There will be a greater demand for PHC teaching of students, and for the PHC specialty training of young professionals in medicine and allied professions.

and more orientated towards the needs of the local communities, and to look for educational strategies that help students to choose for career paths in primary healthcare and family medicine. Moreover, there is the challenge to bridge the gap between public health and PHC, as Margaret Chan (Director General of the WHO) states in her message: “(We need) public policy reforms that secure healthier communities, by integrating public health actions with primary care, by pursuing healthy public policies across sectors and by strengthening national and transnational public health interventions”.

Chris van Weel | President, Wonca; and Jan de Maeseneer | Secretary General, The Network: TUFH Email: c.vanweel@hag.umcn.nl; jan.demaeseneer@ugent.be

THE NETWORK: TUFH IN ACTION ANNUAL INTERNATIONAL CONFERENCE Every year The Network: TUFH organises an international scientific and networking conference. Here you find a retrospective of this year’s Conference (Chía-Bogotá, Colombia, from September 27 - October 2), and a preview of the 2009 Conference in Amman, Jordan.

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‘‘This Group Represents a Support System like No Other’’ Happily, some things never change. The Network: TUFH’s 2008 annual Conference again offered an unprecedented variety of people, cultures, roles and stages of careers, all oriented towards one thing: promoting equity in health through community-oriented education, research and service. Thanks to the staff and the Conference Evaluation Committee, we were able to better understand what worked well and what may need improvement, to inform the organisers and presenters in Jordan for 2009. The Bogotá Conference achieved an overall organisation score of 4.7 out of 5, not an easy task with a group so large and diverse. Our qualitative interviews of 28 meeting

ticipants to share in their communities. This group represents a support system like no other. Although we all have our home communities, The Network: TUFH is its own international community, one with ties that bind intellect, emotions and mission.

as a Culturally Appropriate Church Health Promotion Tool by Women for Women, by Godwin Aja and co-author (Babcock University, Nigeria). • Poster Award: Providing Care off the Beaten Path: Adventures at Pajarito Mesa, by Erin Corriveau and co-authors (University of New Mexico, USA). • Student Poster Award: Implementation of Hygiene Habits and Strategies for the Prevention of Intestinal Parasites in the Academic Community of Marco Fidel Suárez, by Zayrho De San Vicente Celis and co-authors (Universidad de La Sabana, Colombia). • Honourable mention: Multimedia Game to Recognize the Risks and Prevention of Accidents as an Educational Strategy for a Rural Community, by Ana Maria Simbaqueba Community and co-authors (Universidad de La Sabana, Colombia). • Honourable mention: Community Education on Child Health with Information Technology and

Communication to Contribute to Human Development, by Carolina Valasquez and co-authors (Universidad de La Sabana, Colombia). • Honourable mention: IMCI Strategy Sensibility Compared to Triage Classification in Terms of Attention Priority, by Andrea Palacio and coPriority authors (Universidad de La Sabana, Colombia).

Thanks to all of you who contributed to the evaluation, and we hope that you too find value in the feedback. See you all in Amman, Jordan in October 2009. Have a safe and productive year. Joe Ichter | On behalf of the Evaluation Committee Email: joeichter@hotmail.com

Winning Posters At every Network: TUFH Conference a Poster Award Committee is installed with participants from different regions, countries, staff and students. This committee judges all the posters in the permanent poster display. As we realise that access to the latest high-tech in poster production and artwork is not evenly spread around the world, the dominant criteria to assess the posters are: • Clarity: is the poster’s key message immediately clear to the reader? • Relevance: is all information provided pertinent to the message? • Concision: is the information as limited as possible? • Appeal: will the poster attract participants’ attention? • Readability: is the lettering clear and large enough? The following posters were awarded with a prize during the Network: TUFH Conference in Chía-Bogotá, Colombia: • Best Poster Award: Adapting Women and Health Learning Package (WHLP)

participants triangulated much of what was provided in the open question section of the Conference evaluations. Those reports citing “areas to be improved” included the challenges of having to choose from so many interesting topics, the accommodation of each participant’s cultural expectations, and the need to be sensitive to economic realities of partner countries. Participants went on to praise the community site visits, the networking opportunities and the interactive nature of the sessions. The prevailing comment on “what will you take home” was the knowledge that there are colleagues at the corners of the earth who have been working on similar issues, and there is now evidence for par-

Best Poster by Godwin Aja

Jumping into the Deep for a Trial by Fire

“We could count on a wonderful group of student volunteers, our hired meeting organisers and the Maastricht team”

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Francisco Lamus Lemus | On behalf of the Organising Committee Email: francisco.lamus@unisabana. edu.co

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See you all again in Amman, Jordan in 2009.

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Among the new things we can count was the accelerated course in international diplomacy; some of us had to learn the culture and pace of a world apparently beyond our frontiers in the health field. Thanks to support given by several effi-

Now the Conference is over, and we face the emptiness left by this wonderful group of people, we look back and feel a special privilege of having had the opportunity to have this keen group of people visiting our house, where we share the struggle to build better health for all through improvements in health professions education.

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Learning to host a conference is something that happens with the flow of events between the time when the site is accepted and when finally the nine days of the conference flow by. It took us into an interesting series of complicated tasks where we had the unique experience not only to learn new things, but also to challenge the quality and capacity of what we had as a School of Medicine.

During the Conference, you have the strange feeling that there is not much to do. Probably because most of the things had already been organised and delegated. In our case, we could also count on a wonderful group of student volunteers of our school. And we merged successfully with our hired meeting organisers and the Maastricht team.

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When we decided to apply to be conference organisers, we made the ‘jump into the deep’. Meaning: if you are learning to swim, you start at the shallow end of the pool. If you think you can swim with no lessons, you jump in at the deep end. Taking that decision was certainly deciding to swim with no lessons, but we were confident that we had the persons and institutions to support the decision.

cient officers of the diplomatic offices around the world, we can say that with very few exceptions every participant who planned to come to the Conference was able to do so. We also had the tight communication process developed with Maastricht, in order to select the Conference venues, the theme, and all the other events.

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Sayings capture nicely complex emotions and experiences that go beyond time and space. The articulation of two sayings into one sentence summarises perfectly the Bogotá 2008 Conference: ‘Jumping into the deep for a trial by fire experience’.

BOGOTÁ BRIEFING ON PRIMARY HEALTHCARE The Network: TUFH, bringing together 345 people from 31 countries at its annual Conference in Bogotá: • endorses the fact that the World Health Report 2008 will focus on Primary Healthcare (PHC), 30 years after the Alma Ata Declaration, as there is now evidence that health systems based on strong PHC are most effective in providing relevant, equitable, accessible, high quality, cost-effective care and achieving better health; • calls upon all institutes for education of health professionals to improve the social accountability of their training, research and service programmes, orientating them towards the needs of the local communities, integrating and emphasizing the principles of PHC in their curricula and ensuring that their students have adequate experience in PHC-settings; • supports the upcoming developments of interprofessional training and communityorientation of educational programmes as a contribution to comprehensive and integrated care and to intersectoral action, to tackle social inequalities in health; • encourages Governments to ensure the central role of PHC in the healthcare system as the first-contact to the system through reorganisation, re-orientation of funds towards PHC and through adequate support for recruitment, education and retention of PHCworkers so that PHC becomes an attractive workplace for all health professionals; • encourages civil society organisations to participate actively in the development of PHC and the empowerment of the population; • calls upon donor organisations to invest, by 2015, 15% of their funding for vertical diseaseoriented programmes in the strengthening of local PHC-systems (see: www.15by2015.org); • asks the World Health Organization to establish in its structures a high-level unit for PHC, which cuts across vertical disease-oriented programmes. The Bogotá Briefing is also available in French and Spanish at www.the-networktufh.org/ about_us/brochures.asp

THE NETWORK: TUFH IN ACTION ANNUAL INTERNATIONAL CONFERENCE

No Teachers or Students, Just Participants THE 2009 CONFERENCE During October 10-15, 2009 The Network: TUFH will organise its annual Conference in collaboration with the Faculty of Medicine, University of Jordan. This Conference will be held in Amman, Jordan. The theme of the Conference is Achieving Quality in Health Care: Challenges for Education, Research and Service Delivery.

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Paulo Marcondes Carvalho surrounded by students during the Dinner & Dance In the past I had the opportunity to attend the Network: TUFH Conferences in New Mexico and in Londrina. This year I was invited by FAIMER; I was very happy with this invitation, because attending previous Network: TUFH Conferences had been highly valuable to my career as a medical educator; I am still using several skills and insights acquired there, mainly when I am part of an organising scientific committee (for example, the poster session that we included recently at the Brazilian Medical Education Congress). I participated in a pre-conference workshop. There were few participants, but still it was an amazing day! Because it lasted a whole day, we had the opportunity to discuss and explore the topic in-depth. And I made friends with whom I interacted during the whole Conference. In essence, the Network: TUFH Conference programme is intense and mixed. It covers many key topics of the health sciences curricula, such as medical education, project management, partnership, et cetera. Collective discussions and reflection moments are privileged; this is one of the few conferences that I attended where concepts of active learning are being used in practice. All participants are responsible for the sessions, not only facilitators and key-note speakers. Other very strong key points this year were the site visits and parties. All site visits were supported by the youth service of Bogotá 6

Mayor, always kind and supportive in their yellow jackets. The visit to University of La Sabana showed us an audacious university, fully prepared to face new millennium needs, but settled and in respect of their tradition. My group also visited the health facilities of Ciudad Bolivar, a large place with a lot of poverty and problems, but also with many people who are concerned with helping each other and meeting local health needs. The parties, dinners and reception offered delicious food and were a lot of fun. Here we could strengthen our friendships. At the Bogotá Conference I met many old friends, but I also interacted with many new people from all around the world. I also got to know students, in my role as a mentor or just through casual conversation. It seems to me that this Conference knows no teachers or students, just participants. There is no hierarchy and all connections are made easily. During the Latin-American meeting we discussed how to increase participation of schools from this region in a structural way. I think we must fight together to increase Latin-American participation into The Network: TUFH. Let’s hope that many of us can be in Amman in 2009, including myself!

Paulo Marcondes Carvalho Junior | Marilia Medical School, Marilia, Brazil Email: paulo@famema.br

After the Conference (October 16, 2009) you can participate in the following Post-Conference Excursion: Mu’tah University, Karak, Jordan. Available from early 2009: Conference site: www.the-networktufh.org/conference Preliminary programme: www.the-networktufh.org/conference/ programme.asp Registration: www.the-networktufh.org/conference/ registration.asp Abstract submission (for Thematic Poster Sessions): www.the-networktufh.org/conference/ abstractchoice.asp Proposal submission (for Mini-workshops or Didactic Sessions): www.the-networktufh.org/conference/ abstractchoice.asp

BOOK REVIEW

Awakening Hippocrates Book review of: Awakening Hippocrates: A Primer on Health, Poverty and Global Service Author: Edward O’Neil, Jr ISBN 1-57947-772-0, 502 pp. “Never underestimate the ability of a small group of committed individuals to change the world. Indeed, they are the only ones who ever have”. - Margaret Mead

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This review has been published before in Education for Health, Volume 20, no. 3, 2007.

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Reference STARFIELD, B., SHI, L., & MACINKO, J. (2005). Contribution of Primary Care to Health Systems and Health. The Milbank Quarterly 83 (3), 457–502.

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So although we must support the eradication of poverty and of structural violence, we must also work to truly strive for the accessibility of quality primary care for all. The funding that goes towards the vertical public health programmes for disease control - such as the fight to prevent malaria and tuberculosis - are having some impact on health indicators as documented by

O’Neil’s book is a wonderful compendium of back ground information and inspirational stories that should encourage health professionals to work globally. Let us hope that it will also serve as a catalyst for discussions by policy makers about what has worked, and what has not, to achieve quality, accessible healthcare for all.

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O’Neil reports to us about how we have tried to improve health in the world through agencies such as the United Nations and many non-governmental organisations. He also examines the forces of disparity looking at e.g. trade, racism, governance,

Primary Care From cover to cover, Awakening Hippocrates does stir up the reader’s emotions about the state of health and the tremendous disparities that exist around the world. To that end, Edward O’Neil has been successful. However, through his very detailed and careful navigation of these waters he does neglect an important opportunity. There is no mention of the value of primary care in improving health. Barbara Starfield and other authors have repeatedly demonstrated that evidence shows that primary care helps prevent illness and death, and that it is associated with a more equitable distribution of health in populations. This is a finding that holds in both cross-national and within-national studies. In addition, the means by which primary care improves health have been identified (Starfield, 2005).

O’Neil. However, when one looks at the Millennium Development Goals, perhaps the best opportunity to achieve them lies in the training of a primary care workforce of healthcare providers, to allow access to high quality care.

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Engagement In his first chapter O’Neil discusses the forces of disparity which propagate illness. He tells us that the greatest enemies of good health are poverty and structural violence. O’Neil wants his readers and all health professionals to engage in not only understanding the disparities in health, but in becoming part of the solution. He then goes on to lay out the case for the current state of health in the developing world. He tells us there are three simple observations: the first is that most wealthy countries have “a large cadre of healthcare providers whose healing powers now reach unprecedented levels”; the next, that our profession concentrates our knowledge and skills for those who can afford them; and finally, that “there is an ethical imperative that compels us to care for all who need us”.

Following this display of information, there is then a shift of focus to give the reader examples of physicians who have worked in parts of the world with the greatest health disparities. O’Neil uses these vignettes to demonstrate the ‘power of direct action’. Some of these individuals are iconic figures for most health professionals: Albert Schweitzer, Tom Dooley, Paul Farmer. All of their stories remind us that as individuals we can do something to improve the health of others.

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This essentially describes the thesis of Edward O’Neil’s book. His desire is to make the case that as health professionals we should all engage in a global work force to improve health in the parts of the world where others are less fortunate than we are.

population growth, environmental events, ethics, religion, and human rights.

Alain J. Montegut | Department of Family Medicine, Boston University Medical Centre, United States of America Email: jgravdalmd@gmail.com

THE NETWORK: TUFH IN ACTION POSITION PAPER The Network: TUFH Executive Committee decided to undertake the writing of a series of ‘Position Papers’ on issues that are closely related to the aims and objectives of our organisation. They must be seen as starting points for further discussion. You may contribute by submitting a letter to secretariat@network.unimaas.nl, by participating in sessions on these issues at Network: TUFH Conferences, or responding to the electronic versions of these Position Papers at the Network: TUFH’s website (www.the-networktufh.org/publications_resources/positionpapers.asp).

Review Position Paper on Interprofessional Education and Practice

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From my position as a practising nurse and visiting lecturer, I commend this paper for its clarity of the current standing of Interprofessional Education (IPE) and its provision in today’s academic and practice market place.

Significant strides have been made and solid foundations set on which to build further great developments. Through the formation of student networks, focus groups and taskforces, hand in hand with the nurturing of strong collaborative links, IPE has been granted a valuable place on agendas in many significant boardrooms, both in the academic arena as in public and private practice. Now is the time to build further on these exciting and valuable developments and to empower students and those who work closely with them to take charge and ownership, driving the strategy forward for the next generation of learners and workers. I echo the call for clinicians and practice educators, together with their students, to be prepared to embrace and learn from effective IPE experiences, and to expect to build them into programmes of academic study. I commend students who have gone the extra mile to take charge of their learning through memberships of magnificent organisations such as CAIPE and EIPEN, and initiatives such as the UK Interprofessional Student Network. What I would like to see is for this to be taken forward to the next stage, where students not only comply and expect to encounter IPE, but where they shape and plan it, relating to their academic studies in order to

furnish themselves with the key attributes required of professionals working together effectively toward a common aim. This aim is increasingly being underpinned and rolled out through real life tangible case studies where students and academic staff engage in learning from, with and about each other and the subject matter simultaneously. One such medium being the use of simulation to allow situations to unfold and play out to various endings achieved and determined by how the learners interact and plan together to achieve a common goal. I commit my support to initiatives such as this and to the valuable work being undertaken by all parties and bodies in incorporating IPE in real terms into the academic curriculum, and to practice educators, mentors and preceptors who ensure its incorporation into everyday working practice. I believe there is still a great deal more to be achieved and it is essential that the correct people are empowered to drive the initiative forward. I believe the future relating to IPE and this Position Paper is substantial and inspiring. Nicholas Gee | Founding Member UK Interprofessional Student Network; Registered Nurse - Child; Visiting Lecturer, Centre for Excellence in Teaching and Learning, Birmingham City University; Senior Nurse, Integrated Disabled Children’s Service, Derby City Primary Care Trust, United Kingdom Email: nicholas.gee@bcu.ac.uk

THROUGH THE FORMATION OF STUDENT NETWORKS, FOCUS GROUPS AND TASKFORCES, HAND IN HAND WITH THE NURTURING OF STRONG COLLABORATIVE LINKS, IPE HAS BEEN GRANTED A VALUABLE PLACE ON AGENDAS IN MANY SIGNIFICANT BOARDROOMS, BOTH IN THE ACADEMIC ARENA AS IN PUBLIC AND PRIVATE PRACTICE.

INTERNATIONAL HEALTH PROFESSIONS EDUCATION LEADERSHIP COLUMN

Creating a New Style of Medical Doctor This article was based on an interview that Jane Westberg held with Camilo Osorio Barker (Dean of the Faculty of Medicine of the Universidad de La Sabana in Chia, Colombia|camilo.osorio@unisabana.edu.co) at the Network: TUFH Conference in Uganda as well as follow-up email communications. A longer version of the interview was published in Education for Health Volume 21, issue 2.

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One of the most important challenges has been establishing our special identify. We want our graduates to be known not only as well educated in medicine, but as physicians who have a special relationship with their patients and understand their patients’ problems in the context of the patients’ family and community.

What are your hopes and dreams for medical education and healthcare in Colombia? Our big dream is to prepare new medical professionals who have the skills and tools to improve the health of our communities in our country and all of Latin America. These new medical professionals must be medically competent, but they also need to be committed to treating people with dignity and seeing them as part of the family and community. Medical doctors must recover their historic role as positive leaders of society.

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In 2001 I was asked to be Dean of the University of La Sabana, which had been established in 1994. I was reluctant to accept the position, but saw that the university had an incredible programme and a clear future, so I accepted.

My three goals were: to get accredited, to get the rest of our funding, and to consolidate the academic programme, which meant developing graduate programmes. Accreditation is voluntary but we felt it was very important. There are more than 50 schools in Colombia, but only 13 are accredited. When we were only 10 years old we became the youngest school of medicine in Colombia to be accredited. Now we have re-accreditation for six more years.

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In 1993 I began working to create a university hospital. I worked for seven years on that project and was involved in all phases of the hospital, from its conceptualisation to the equipment and personnel.

The general idea was to create leaders of change; a new style of medical doctor who thinks of patients as whole people. There was an attempt to understand human beings not only from a scientific point of view but also from an anthropological point of view.

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After working two years, I went back to my Alma Mater for four years as the first-ever general surgical resident. This was a very stressful, unpleasant time. It was very hierarchical. This made it difficult to have a friendly atmosphere in which to work as a team. Since that experience, in every place that I have worked, I have tried to create a more collaborative atmosphere. Now, at the Universidad de la Sabana, I’m trying to create a collaborative atmosphere with the help of the faculty and staff.

Dr. Camilo Osorio Barker

Currently we are in the process of a curricular reform. Until one year ago, fourthyear students who had just completed the three years of basic science, had a whole semester dedicated to family and community medicine. We still have such a semester, but now students will have this experience in their twelfth semester. Students will be given opportunities to work in the schools, but they will also be able to choose to work in other community settings. We think that if students have had time to develop basic competencies in various clinical areas, they will be able to get more out of their community experience. At the same time, we think they will be able to provide better services to the community.

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What was your pathway? In 1978, when I was 17 years old, I began studying medicine at the Universidad Pontificia Bolivariana in Medellín (Colombia). After the internship, I had to spend a year in a rural practice. I went to a small hospital in the rural mountains in my region, where I became the director. The next year the governor asked me to direct a bigger hospital, Santa Sofia de Fredonia.

What is the curriculum like? We have a classical structure, but we are working to integrate the basic sciences and clinical medicine. We have a competency-based programme that is seven years long, including the internship. Most schools in Colombia are only six years long, but we want students to have time to develop a humanistic perspective.

INTERNATIONAL HEALTH PROFESSIONS EDUCATION PROBLEM-BASED LEARNING AND COMMUNITY-BASED EDUCATION

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Enhancing Medical Education and Scholarship in Uganda

In response to invitations from Dean Jerome Kabayenka and faculty from Mbarara University of Science and Technology (MUST) - and with support from Global Health through Education, Training and Service (GHETS) - we spent eight eventful weeks in Mbarara working with faculty and students. During this time, we participated in MUST’s endeavours to train generalist physicians, strengthen primary care research, and provide community-based medical education (CBME). We focused our combined experiences in public health research and family medicine on providing a boost to these exemplary efforts to bridge the gap between the population-based approach of community health and the person-centred orientation of the generalist physician. Our synergistic backgrounds converged as we assisted five family medicine graduates with their dissertations. Their projects addressed a variety of critical community health problems such as: prevention of mother to child transmission of HIV/AIDS, prevention of HIV/AIDS in adolescents, and promotion of community involvement in planning and implementing rural healthcare services. Subsequently, these physicians successfully defended their research and received their Masters degrees in Community Practice and Family Medicine, thus increasing the pool of qualified family doctors in southern Uganda. We also participated in CBME and COPC activities at Rugazi Health Centre IV, 79 kilometres from Mbarara. Over the past several years, GHETS has provided funding to convert this centre into a teaching/ patient care facility which hopefully will become what has been termed ‘the first model peripheral training complex in Uganda’. Medical and nursing students from MUST and Makerere University train at this rural setting, immersed in clinical care and community health activities that elucidate the close relationship between health

and the context of peoples’ lives. Students spend their mornings with patients at maternal and child health clinics, the outpatient department, the HIV/AIDS clinic, and the hospital unit. Afternoons are devoted to community activities which include providing health education in schools and assessing living conditions and health hazards during home visits. They also visit birth attendants and other traditional healers, health centres II and III, and communitybased nongovernmental organisations. We were impressed by the students’ self initiative and the way in which they organised and reported these experiences. Mary Kay worked with Gad Ruzaaza, coordinator of CBME, and Vincent Batwala on evaluation methods for the CBME experience. They drafted educational objectives which will be incorporated into the course syllabus and used as the basis for designing process and outcome evaluation instruments. Vincent gave presentations, reviewed curricula, provided mentoring, and identified strengths and challenges pertaining to the family medicine programme at MUST. He also spent time with Atai Omuruto and Anthony Musisi Kyayise at Makerere University, reviewing curricula and the progress of the family medicine and community practice residency. Many of the challenges confronting the family medicine programme and CBME relate to limited resources and scarce faculty. Family medicine also faces conceptual difficulties especially when residents rotate through specialty services where objectives for their training may not be understood or appreciated. A significant constraint for the CBME programme is the increased cost of living for students and the additional drain on faculty in order to provide teaching, guidance and supervision. Possible solutions, which are being considered or in the

Working with faculty and students at Mbarara University of Science and Technology process of implementation, include obtaining financial support from the Ministry of Health for residency stipends, equitable salaries, and incentives for those practicing in rural areas, and faculty development with emphasis on the importance of training generalist physicians to meet the needs of the communities and patients whom they will serve. Other initiatives include sharing of resources such as curricula, educational modules, and research expertise through collaboration with the fledgling East Africa network of family medicine programmes; and developing decentralised training sites in district hospitals, church supported hospitals and level IV health centres. Throughout this profound experience, we were inspired by the perseverance and competence of the colleagues with whom we worked and the equanimity and dignity of the patients with whom we interacted. Likewise, we were impressed by the academic initiatives at Mbarara and Makerere universities. These institutions provide valuable lessons for affluent countries as well as those with fewer material resources, as they strive to reduce the overwhelming burden of disease through comprehensive primary healthcare. Vincent Hunt and Mary Kay Hunt | Professor Emeritus, Department of Family Medicine, Warren Alpert Medical School of Brown University, USA - Adjunct Professor, Department of Family Medicine and Community Health, University of Minnesota Medical School, USA - Project Manager, Wonca East Africa Initiative; Senior Research Scientist, Dana-Farber Cancer Institute & Harvard School of Public Health, USA Email: vrhunt@comcast.net

NEW INSTITUTIONS AND PROGRAMMES

Last Year of the Maastricht Medical Curriculum: HELP and SCIP

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Evaluation Throughout the last three years, all students and elective conductors have been asked to evaluate this new system. From this evaluation, it can be concluded that this organisational instrument is ideally equipped to allow professional training of students in the transitional phase between graduate education and residency, respectively post-graduation specialisation.

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The second measure taken in order to organise adequate and fair streaming, is

Regarding the competency development during both electives, the Board has adopted the seven CanMEDS domains, because they are also used in the postgraduate education phase. In order to evaluate this development, the junior doctor is evaluated permanently throughout the elective. The evaluation is based upon several evaluation instruments, like short clinical observations (SCOs), 360º observations, critical appraisal of topics (CATs), oral presentations, written reports (important for the research elective), student reflections, and reports of weekly discussions. All this material is gathered into a portfolio, for which the student is held responsible. At the end of the elective, after a conclusive discussion, the elective

THIS ORGANISATIONAL INSTRUMENT IS IDEALLY EQUIPPED TO ALLOW PROFESSIONAL TRAINING OF STUDENTS IN THE TRANSITIONAL PHASE BETWEEN GRADUATE EDUCATION AND RESIDENCY.

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Adequate Streaming Since 2005, every year about 340 students follow both electives. To allow an adequate streaming of students to their favourite elective, the Board of Participation Electives has chosen to build an electronic environment in which all the proposals for electives can be found. To ascertain the quality of the offered programmes, all proposals for electives are screened by the Board and have to be approved before advertisement.

Protocol and Portfolio Before the start of each elective, students have to submit a written protocol for approval by the Board. Students have to describe – based upon a prior made strength-weakness analysis – how they will construct their elective (using the SMART principle).

conductor gives an advice for a grade. The final grade is determined by the Board, and is based upon an independent judgment of the portfolio and upon the advice of the elective conductor.

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Although the majority of the students prefer electives in the academic hospital Maastricht or affiliated hospitals in the neighbourhood, a substantial number (on an annual base circa 50 students), select an elective(s) in a foreign country. When students perform a clinical care elective in a foreign country, a proper knowledge of the native language is required.

that students have to apply for their favourite elective. The applications are transmitted to the respective departments which are responsible for the organisation of the selection procedure. A first selection is based upon written applications. If positive, students are invited for an interview. The advantage of this system is that it allows an ideal coupling of elective conductor and student. Indeed, the first can make a proper selection out of several candidates; the second one is allowed to refuse a positive selection, for instance because (s)he prefers another offer. In general, over the last three years this system has worked very well. A back-up had to be organised to mediate additional interviews for a limited number of students that were not selected in the first round.

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Medical students at the Faculty of Health, Medicine and Life Sciences of Maastricht University follow a curriculum consisting of three pre-clinical bachelor years and three master years of clinical training. During the last year in the master phase after the required clerkships - students perform two electives, each of which takes 18 weeks. These electives concentrate respectively upon participation in clinical care (HELP) and scientific research (SCIP). In the HELP, the student becomes junior doctor, which will facilitate the transition to the postgraduate phase. The student is responsible for a number of patients. During the SCIP, the student participates in the daily activities of the university research institutes, and performs a selfdesigned research project. If appropriate, both electives can be combined to one elective.

Luc Snoeckx | Chairman Board of Participation Electives, Faculty of Health, Medicine and Life Sciences, the Netherlands Email: l.snoeckx@fys.unimaas.nl 11

INTERNATIONAL HEALTH PROFESSIONS EDUCATION YELLOW PAPERS Between those outstanding publications that were already published in leading journals, and some preliminary notes scribbled on the last page of an agenda, there are also papers or reports that belong to the in-between (‘grey area’) category. Papers that, for whatever reason, have not been published before. Within this ocean of ‘grey’ papers, there are some which by content are most relevant to the Network: TUFH’s mission and aims. We will pick those pieces of gold from the ‘grey’ ocean, change their status to ‘yellow’ (because we can’t print in gold) and publish these in this section. Here you will find two of such yellow papers.

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Attitudes towards Computer Education in Medical Curriculum In many universities, computer education is introduced and implemented in the medical curriculum. Computer utilisation is becoming essential for medical students in assisting their medical education, especially using the Internet as an important medical resource. Likewise, the use of computers in medicine is becoming indispensable and doctors must be prepared to use them. Since 1991, computers have been utilised as part of the educational approach in the School of Medical Sciences (SMS), Universiti Sains Malaysia (USM), with the introduction of Computer Aided Instruction (CAI). CAI helps medical students understand certain medical subjects; it has also been used to supplement or replace traditional methods, where the logistics for large student numbers are otherwise prohibitive (Ward et al., 2001). Recent curricular innovation has integrated the electronic learning (e-learning) concept in years one to three. Research In 2003, a self-administered questionnaire was issued to approximately 60 second-year and 60 final-year medical students. The aim was to find out what attitudes medical students in year 2 and in the final year of SMS had towards computer education, and whether there was any significant difference between the two groups (it was assumed that these two different groups may differ in their attitude towards computer education). The data could give some input and assist the implementation process of computer education in the medical curriculum. The questionnaire was returned by 78% (n=47) second-year and 88% (n=53) finalyear medical students. The study showed 12

Subscales

Year 2 Total group/mean (SD)/n Computer education 47/20.9 (2.82)/ 44 CAI lab 47/10.7 (1.98)/ 47 Computer and learning 47/16.7 (1.99)/ 47 Computer and 47/11.1 (2.29)/ 44 medical practice Total score 47/53.9 (5.71)/ 44 * independent t-test

Year 5 Total group/mean (SD)/n 53/19.0 (3.68)/ 50 53/9.0 (2.38)/ 52 53/14.4 (3.21)/ 53 53/9.2 (2.26)/ 51

t Statistic* 2.88 3.83 4.49 4.02

p value* 0.005 <0.001 <0.001 <0.001

53/46.5 (8.52)/ 49

4.95

<0.001

Table 1: Comparing subscales score, and total score between second- and fifth-year students that both groups scored positively (mean score higher than 2.5) in their attitude towards computer education in a medical curriculum. It is argued that early exposure to computers (prior to admission to the medical school) has a big effect on students’ attitude towards computer education. Finalyear medical students were not exposed to computers as much as second-year students; more second-year students had previously attended computer courses (in secondary school or in private). The study showed that second-year medical students scored a significantly higher Total Attitudinal Score than final-year medical students (p value <0.001) (Table 1). The argument stated above is supported by the partial correlation analysis that was carried out to find significant influence of the variable ‘previously attended computer course’ on the subscales and the total scores. All means of subscales and total scores of second-year and final-year medical students were not statistically significantly different when the variable of ‘previously attended computer course’ was controlled. Recommendations Computer education should be implemented as a small educational step to promote

appropriate integration in the medical curriculum. More studies need to be done regarding computer education in the medical curriculum, especially in Malaysian medical schools. Second-year medical students should be followed-up to their final year to see if there is any change in their attitude over time. Graduates of SMS should also be assessed during their early years in practicing medicine. Studies on teachers’ attitudes are also important to assess their current attitude towards information and communication technology. Reference WARD, J.P.T., GORDON, J., FIELD, M.J., & LEHMANN, H.P. (2001). Computer and information technology in medical education. The Lancet Lancet, 357, 792-796. Nik Fakri and Henk van Berkel | Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Malaysia; Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands Email: nrizal@kck.usm.my; h.vanberkel@educ.unimaas.nl

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The experience in UiTM can provide a possible model of cross-curriculum communication skills training to be implemented in a devel-

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Conclusion With the current demand of quality healthcare delivery, there is no doubt that communication skills training should be integrated across the continuum of the medical education in consistent and effective ways. Research reveals that although communication skills can be learned in medical schools, it also can be forgotten if training is not sufficiently targeted and reinforced throughout medical education (Craig, 1992; Davis & Nicholaou, 1992).

References CRAIG, J.L. (1992). Retention of interviewing skills learned by first-year medical students: A longitudinal study. Medical Education, 26, 276-81. DAVIS, H., & NICHOLAOU, T. (1992). A comparison of the interviewing skills of first and final year medical students. Medical Education, 26, 441-7. ECONOMIC PLANNING UNIT (2006). Ninth Malaysia Plan 2006-2010. The Prime Minister’s Department Department, Putrajaya, 559. KURTZ, S., SILVERMAN, J., BENSON, J., & DRAPER, J. (2003). Marrying content and process in clinical method teaching: Enhancing the Calgary-Cambridge Guides. Academic Medicine, 78, 802-9. MINISTRY OF HIGHER EDUCATION MALAYSIA (2006). Development of soft skills module for institutions of higher learning. Universiti Putra Malaysia. SILVERMAN, J., KURTZ, S., & DRAPER, J. (2005). Teaching and learning communication skills in Medicine. Oxford/San Francisco: Radcliffe Publishing Ltd.

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Challenges and Future Directions Although great measures have been taken to standardise the teaching framework and methods, the greatest challenges remain in increasing the Faculty’s teaching expertise and inculcating positive attitudes towards communication skills teaching and rolemodelling. Yearly workshops are conducted to improve faculty skills. Improvement of the infrastructure, for example, building a communication skills laboratory, is well under way. There are also ongoing researches in evaluating the effectiveness of the programme and assessing students’ attitude towards communication skills learning.

oping country where resources and teaching expertise in this field is limited. The Faculty has high hopes that it will realise its mission to produce medical graduates who are not only clinically competent, but who are also imbued with strong interpersonal communication skills that will make a difference in the way medicine is being practiced in Malaysia.

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Following extensive literature reviews and discussions amongst the local experts, the Faculty chose the enhanced CalgaryCambridge Guide to the Medical Interview (Kurtz et al., 2003; Silverman et al., 2005) as the basis to formulate the cross-curriculum communication skills training. This enhanced guide identifies a total of more than 70 core, evidence-based communication process skills

The training programme was implemented from the academic year 2005/2006 across the five-year undergraduate curriculum.

Communication skills teaching

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Evidence-Based Approach In the bid to equip the students to face new challenges and public expectations, the Faculty of Medicine, Universiti Teknologi MARA (UiTM) in Malaysia, took a step forward by introducing a comprehensive, crosscurriculum communication skills training as part of the ‘hybrid’, integrated and seamless undergraduate medical curriculum. This was to realise the Faculty’s mission to produce competent doctors with solid scientific foundation imbued with strong humanistic values and soft skills.

that fit into the framework of tasks and objectives. The group of researchers found that unless communication skills are integrated with history taking, physical examination, and medical problem solving, learners are unlikely to apply communication skills they have learned in real-life medical practice. The guide marries the ‘process’ and the ‘content’ of the medical interview.

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The concept of regarding patients as partners in managing their own health is pivotal in the delivery of quality healthcare in the st 21 century. Central to developing this partnership is effective doctor-patient communication. However, numerous studies indicate widespread deficits in doctor-patient communication and interpersonal skills. Recognising the shortfall, the World Federation for Medical Education recommended in 1994 that communication skills should be an essential component of medical education. In Malaysia, one of the major weaknesses of graduates is the astounding lack of ‘soft skills’ demanded by society and the competitive job market (EPU, 2006). To address this lack, the Ministry of Higher Education identified seven ‘soft skills’; one of these was communication skills, which was also identified as one of the important components that lacked in the current human capital of Malaysia (MOHE, 2006).

Anis Safura Ramli | Corresponding author; Senior Lecturer & Primary Care Medicine Discipline Coordinator, Faculty of Medicine, Universiti Teknologi MARA, Malaysia Email: rossanis_yuzadi@yahoo.co.uk 13

INTERNATIONAL HEALTH PROFESSIONS EDUCATION SOCIAL ACCOUNTABILITY

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Pajarito Mesa: How a ‘Little Bird’ Took Flight

Imagine for a moment what it would be like to live in a community where the landscape consisted of miles and miles of dusty plains peppered with humble, flat-roofed homes, and a climate too dry to support much more than a sage bush here and there. And what is more, imagine life there is quite challenging: no running water, no electricity, no sewage, no paved roads, no mail service and set apart from the conveniences enjoyed by people residing in the nearby modern city. The place I describe exists. It is the community of Pajarito Mesa, a non-border colonia located six miles south of Albuquerque (New Mexico, USA), at the rim of the main city dump. A couple of years ago, residents and attending physicians at the University of New Mexico (UNM), Department of Family and Community Medicine (F&CM) caught site of Pajarito Mesa, and found that its health needs were as vast as its stark, dusty landscape. Colonias New Mexico is a unique state because over 50% of the population consider themselves part of an ethnic minority. Whereas people of all ethnicities generally live in harmony, there is an unfortunate, but also common negative view regarding undocumented minorities. Because New Mexico is situated along the US-Mexico border, there are many people who enter the USA through New Mexico without documentation, seeking a better life for their families. Once in the USA, many of these people live in fear that they may be deported and thus oftentimes live together in clandestine communities called colonias. Pajarito Mesa is such a colonia and is home to approximately 1500 people, most of whom are undocumented Spanish speakers. Most in the community work, pay taxes, but live in fear and poor conditions. Furthermore, when UNM F&CM physicians conducted a needs assessment in the community, clean water and healthcare were top priorities!

Pajarito Mesa community

Mobile Clinic Van Over the course of the past couple years, our doctors have worked with the UNM Law School, the Southwest Organising Project (a community organisation), and with the Pajarito Mesa community itself to make a source of clean water a reality. At the same time, at the request of the community, UNM also began a project to provide healthcare to the community via a mobile clinic van. The van is staffed by UNM attending physicians, residents and students. All comers to the mobile clinic are served on a walk-in basis. Perhaps the most important function of the clinic is to create a trusting relationship with the community by providing good care and then easy follow-up at a nearby established clinic. This helps residents of Pajarito Mesa, who may have not seen a doctor in years, to obtain a medical home that does not discriminate based on documentation. The mobile clinic is free of charge, and patients may be seen for routine medical and gynaecologic care. In January 2009 we will be able to provide the community with free of charge basic medications, a project which was approved quietly by the Board of Pharmacy and UNM Hospital administration.

Addressing Community Needs A project of this magnitude has taught us much about the gap between the University Hospital setting and marginalised communities. As you may imagine, communication with the Pajarito Mesa community has, at times, been challenging. We are constantly reminded we are there not to impose our ideas, but to listen and respond to the needs expressed by the community. Unfortunately, many of New Mexico’s undocumented people face financial, political and emotional barriers to a way of life enjoyed by wealthy citizens of the USA. As we have heard from the Pajarito Mesa community, helping establish a source of clean water, and providing healthcare via a mobile clinic were two small, yet feasible ways a large university could use its resources and expertise to address one community’s needs. While we continue pushing for ‘healthcare for all’ with all our might here in the USA, we can always find creative and meaningful ways of helping those who need it most. In the meantime, my ear is to the ground! Erin Corriveau | Student, School of Medicine, University of New Mexico, United States of America Email: ecorriveau@salud.unm.edu

THE LIKE-MINDED WORKING TOGETHER

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Additional information is available at: www.globalhealthedu.org For more information contact Thomas Hall: thall@epi.ucsf.edu

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Plans for the Future GHEC has prepared a five-year programme plan (2010-2014) that calls for substantial growth, a number of new projects, and the periodic review and upgrade of existing initiatives. Major activities will include the expansion and upgrade of the modules project and other educational materials,

GHEC continues to exert considerable influence within and beyond the consortium of educational institutions committed to improving the health and human rights of underserved populations globally. Through its work to expand and improve educational programmes globally, GHEC in association with like-minded organisations such as The Network: TUFH, seeks to bring closer the day when access to quality healthcare and the full attainment of human rights are realities for all.

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Another project, the Trans-Institutional Alliance for Global Health, was initiated in 2007 with the collaboration of the Centre of Global Health at the University of Virginia. Taking a different but complementary approach, the project has two objectives: â&#x20AC;˘ to characterise the priorities and activities of major North American university programmes directed at transnational institutional capacity building; â&#x20AC;˘ to identify the main problems confronting these programmes and opportunities for reducing them through collective action.

Through most of its existence, GHEC membership and focus has been on North America. In 2007 GHEC named a Vice President of International Operations and through a European partner organisation, is expanding its international operation. GHEC will soon add overseas members and increase international participation in its programme.

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Projects and Products Through projects undertaken and products produced, GHEC seeks to enlist the expertise of its membership in the development of high quality educational materials and programmes for the benefit of all. By means

One exciting project consistent with this approach is the Innovative Medical School Project. The project is an alliance of eight innovative medical schools seeking to train physicians for service in underserved communities. The schools are developing a common evaluation framework with which to measure and compare accomplishments. Participating schools are located in South Africa, the Philippines, Cuba, Australia, Canada and Venezuela.

collaborations with universities in low income countries, faculty training, and evaluation of the effects of global health education and experiences.

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GHEC now has more than 70 institutional members and in the coming years will be working to extend its membership beyond its traditional medical school base to include public health, nursing and other allied professions as well as educational institutions in low income countries. Recently, GHEC held a special symposium in Sacramento, California to celebrate 17 years of Alliances and Leadership in Global Health. During this period, the number of academic centres with global health programmes has grown rapidly.

of its website, listserv, networking groups and conferences, GHEC then makes these resources readily available in the service of improved and expanded global health education programmes. Thus, GHEC seeks to serve as a catalyst for shifting the paradigm of medical education from a purely bio-medical curative model to one more oriented towards public health and which is socially accountable, in keeping with the humanitarian goals of global health.

D E C E M B E R

The initial ideas for launching a university consortium dedicated to promoting healthcare and social equity to disadvantaged populations through global health education arose during a meeting in Washington in 1990. The first consultative and organisational meeting, hosted by the University of Arizona on March 2, 1991, officially launched what was then called the International Health Medical Education Consortium (IHMEC). Faculty and programme administrators from 24 universities attended this meeting and committed the new organisation to raising the profile of global health training in medical schools. In 2005, IHMEC changed its name to the Global Health Education Consortium (GHEC) and broadened its membership to include all other health professional disciplines. Since then, IHMEC/GHEC has sponsored 17 annual scientific meetings hosted by various universities in North and Central America and in the Caribbean. Additionally, GHEC now co-sponsors four to five regional conferences in collaboration with host universities located throughout North America.

Anvar Velji and Thomas Hall | Co-Founder GHEC, Clinical Professor University of California, USA; Executive Director GHEC, Department of Epidemiology and Biostatistics, University of California, USA Email: anvarali.velji@kp.org; thall@epi.ucsf.edu 15

INTERNATIONAL HEALTH PROFESSIONS EDUCATION MEDICAL EDUCATION

Consortium for Longitudinal Integrated Curricula

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The Northern Ontario School of Medicine (NOSM) is the first new medical school in Canada in over 30 years. A joint initiative of Lakehead University in Thunder Bay and Laurentian University in Sudbury (two regional centres more than 1000 km apart), NOSM was established with a social accountability mandate to be responsive to the needs of the people and communities of Northern Ontario. Longitudinal Integrated Clerkship NOSM is the first medical school in the world in which all third-year medicine students undertake a longitudinal integrated clerkship. In four-year medical programmes, students in the third year make the transition from primarily classroom learners to clinicians. The standard model involves the students rotating through sequential blocks (clerkships), each of which provides concentrated learning in a specific clinical discipline (Internal medicine, Surgery, Paediatrics, et cetera). A longitudinal integrated clerkship involves the students in learning the core clinical disciplines integrated together over a prolonged period of time. The NOSM third year is the Comprehensive Community Clerkship (CCC), in which students live and learn in one of 12 large rural or small urban communities in Northern Ontario outside Thunder Bay and Sudbury. The students are based in family practice, where they meet patients and follow them, including into specialist and/or hospital care. Supervised clinical experience is complemented by direct teaching from local and visiting specialists and family physicians, as well as by distance education. The CCC is one of many models of longitudinal integrated clerkships. Different models share common elements: comprehensive patient care over time; continuing learning relationships with clinicians; 16

and learning core clinical competencies across multiple disciplines simultaneously. Generally, all major medical disciplines are taught concurrently in a developmental sequence that integrates clinical medicine with its biological and social science underpinnings. Students develop meaningful continuous relationships with patients and with clinical teachers. Motivated by their intense relationships with individual patients, students develop a strong sense of professionalism and social accountability. They observe the full course of their patientsâ&#x20AC;&#x2122; medical illness and recovery (when possible), learn about the challenges of navigating the healthcare system, and extrapolate to populations when applicable. Through longitudinal relationships with mentors, they receive frequent, developmentally appropriate feedback. This approach lends itself to urban and rural settings, to community and tertiary sites, and to advantaged and disadvantaged populations.

STUDENTS DEVELOP MEANINGFUL CONTINUOUS RELATIONSHIPS WITH PATIENTS AND WITH CLINICAL TEACHERS. CLIC A growing number of medical schools offer models of longitudinal multispecialty integrated third-year clerkships

as a parallel stream to the standard teaching hospital-based clerkship model. In August 2006, NOSM hosted a workshop which brought together representatives from six of those medical schools in North America. Last year, a follow up threeday workshop of this group plus others, known as the Consortium of Longitudinal Integrated Curricula (CLIC), took place in Boston. CLIC is a growing international network of medical schools committed to improving the quality and effectiveness of clinical education. The workshop was hosted by the Cambridge Integrated Clerkship of Harvard Medical School. In 2008, there have been two CLIC events. As part of the International conference Community Engaged Medical Education in the North in June, there were three CLIC Hothouses and the annual CLIC Meeting in November was hosted by the University of California at San Francisco. This CLIC Meeting was attended by 90 participants from 25 different medical schools, many of whom are planning or have just started longitudinal integrated clerkships. Highlights of the programme included keynote addresses on Future Directions for Longitudinal Integrated Clerkships: What Role for Residents and Residency Training? and Longitudinal Integrated Clerkships in the Future of Undergraduate Medical Education, as well as a panel discussion involving former and current longitudinal integrated clerkship students. In addition, there were multiple parallel workshop sessions which explored a diverse range of topics from professional identity development to research questions and initiatives. Roger Strasser | Founding Dean, Northern Ontario School of Medicine, Canada Email: roger.strasser@normed.ca

IMPROVING HEALTH HEALTH AUTHORITIES JMHPE: THIRD GROUP OF GRADUATES th On Sunday the 27 of April 2008, the third group of fellows graduated from the Joint Master of Health Professions Education (JMHPE) programme, developed in collaboration between Maastricht University (the Netherlands) and Suez Canal University (Egypt).

financing target programmes and capacity building of public health services. Directors of hospitals, health centres and specific programmes would be authorised to spend from the funds they raise. I would help in the creation of a system of regulations, policies, procedures and standards in the field of health and care, including medical aid, private practice and patients’ referral, pharmaceutical industry and medical products.

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Finally, improving working and living standards of health personnel should go hand in hand with implementing these changes; this will give them more job satisfaction and increase their productivity, which will be reflected on the standards of healthcare in the country.

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Jan van Dalen and Wagdy Talaat | JMHPE Directors Email: j.vandalen@sk.unimaas.nl; watalaat@ismailia.ie-eg.com

Research in health sciences is very important; it helps planners in setting up priorities, assessing achievements and formulation of health policies. Quality of care, professional achievements and research would be taken into consideration in decisions related to promotions and incentives. I would concentrate on improving the reporting and documentation systems and set a registry for communicable and non-communicable diseases to form a national data-base for health planning and policy making.

Dr. Darwish Badran

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The JMHPE degree is a reward, but it is also a responsibility. The career developments of some of the fellows who graduated earlier bear witness to this: their further career paths include a Deanship, Head of a Clinical Resource Centre and Coordinator of the JMHPE programme! We are proud of the high standard of these pioneers in health professions education reform in the Arab world, and we wish the graduates much success in this exciting endeavour.

Healthcare workers should be encouraged to upgrade and update their knowledge and skills through participation in local, regional or international activities that aim at improving their clinical, research and communication skills. The Ministry of Health should cover the expenses of these activities and offer incentives for those who attend them. Moreover, teaching/ training programmes would be planned and conducted in collaboration with medical schools, teaching hospitals, associations of health professions, NGOs and international organisations.

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The success of a programme can be measured by different parameters: the number of graduates, the number of applicants for the next class, and the regional attraction of the programme. All of these aspects show evidence of the success of this joint programme: • The enrolment increased in the first three years from 10 and seems to have stabilised now at about 30 participants. • In the first group, seven of the ten participants came from Egyptian universities and the remaining three from the East Mediterranean region. In 2008, 14 of the 30 participants still come from Egypt, 12 from the region and two from beyond the region.

Starting the process of change is usually difficult, but a comprehensive national health insurance programme in Jordan is a dream that has to be brought into reality. Every citizen, regardless of colour, religion or place of residence, has the right to receive the best quality of healthcare. Health services should be accessible to those areas and people with the highest need for such services, focusing in particular on tackling inequities in health. D E C E M B E R

Two years after the graduation of the pioneer group of seven, and one year after the second group of 20 graduates, another 19 fellows followed in their footsteps. Thirteen of them graduated with honours, which means that they have received an eight on a ten-point scale for at least half of their unit registrations at first attempt. Ten countries in the Arab region were represented: Egypt, Bahrain, Saudi Arabia, Yemen, Sudan, Jordan, Syria, Palestine, United Arab Emirates and Iraq.

What Would I Change if I Were Minister of Health?

Darwish Badran | Director, Centre for Educational Development, University of Jordan, Jordan Email: dhbadran@ju.edu.jo

An important issue is the improvement of the efficiency of budget allocation, and spending directed at health promotion to the public. It is important to attract nonbudgetary funds, foreign investments and international organisations’ funds for 17

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Health Reform in Colombia

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Colombia is a tropical country, located in the northern part of South America, with 44,000,000 inhabitants; a life expectancy at birth of 72 years (66 years for men and 74 for women); a birth rate of 19.86 per 1000 inhabitants; and with cardiovascular disease, murder, cerebrovascular disease, chronic lung disease and diabetes as the five leading causes of death. Major Changes Since the ‘90s, the country has initiated profound economic and social policies, which resulted in the adoption of a new Constitution (1991). This change established a new organisation of national life. In that context there were three major changes that affected the healthcare system: • First, the establishment of the rule of law, in which education and healthcare are recognised as fundamental rights for all people, without distinction of any order. • Second, the strengthening of decentralisation processes in search of better conditions for development of regions and localities, seeking equitable access of all population groups to opportunities and benefits of national development. • Third, the introduction of a model of economic and social development, with the primary purpose of encouraging institutional pluralism in various public and private fields. The model also incorporates the country into the global flows of political thinking that led the movement of the so-called ‘modernisation of the state’ and the trends of globalisation of economies. System General Health Insurance In Colombia the ‘health reform’ was a total change in the healthcare system. Existing schema fragmented organisation, public assistance for the poor, financed with Government funds; social insurance for workers, public and private, financed by contributions; and private services for the popula18

tion groups with the capacity to finance their healthcare. This National Health System turned into a System General Health Insurance (SGHI) - made up of multiple institutions - which was obliged to ensure, as an individual and collective right, healthcare for the whole population. Since the introduction of SGHI in the year 1993, there has been considerable progress in the rates of insurance coverage. To date, the Ministry of Social Protection estimates that over 90% of the Colombian population is affiliated to the System. Unsatisfactory In connection with the Provision of Health Services, various studies show that the planning, organisation and functioning of the healthcare providers have lost the concept of space-catchment area; they do not take into account the accessibility of the population to them, nor the geographical, cultural, economic, population and epidemiological condition. They ignore the social order in terms of meeting the health needs of the population, which has led to serious problems of equity in income and the provision of benefit plans, and requires the formation of networks to provide services to ensure the user the right to attend them. In connection with public health, the Basic Care Plan has been defined. This plan focuses on complementing the community advocacy and prevention-defined benefit plans. But there is dispersal of activities among the various actors and territorial levels and fragmentation of responsibilities. Therefore, the impact of the shares is dissolved, the attention to people and communities is not timely and sufficient, and there is a loss of transparency in the management of resources. The fulfilment of the shares of health promotion is unsatisfactory in some of the municipalities; these do not report information on

THE CHARACTERISTICS OF THE NEW SYSTEM OF HEALTH SERVICES HAVE HAD SIGNIFICANT IMPACT ON THE FORMS OF LINKAGE AND ON THE PERFORMANCE OF HUMAN RESOURCES IN HEALTH. activities of vaccination, or this information is inconsistent or incomplete. The characteristics of the new system of health services have had significant impact on the forms of linkage and on the performance of human resources in health. Improvement in these key factors in the process of healthcare - individually and collectively - is critical in the implementation and operation efficient, cost-effective and quality. The major challenges are getting to universal health service, and ensuring the quality of provision. Miguel Ruiz Rubiano | Dean, Faculty of Medicine, Universidad el Bosque, Colombia Email: miguelruiz@hotmail.com

WOMEN’S HEALTH

Preventing Paediatric HIV in Rural South Africa

tem and why many women are not offered treatment early enough in their pregnancies to prevent HIV transmission to their infants. Each clinic’s data was illuminating; though many women learned their HIV status, few were having the blood work needed to determine whether treatment was right for them. And of those women giving blood for CD4 counts (a method of determining the immune system’s health), very few were actually told their test results and even fewer were referred for lifesaving treatment.

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Small changes such as these promise tremendous benefits to communities devastated by a growing paediatric HIV epidemic. All of the health workers in this region are touched personally by HIV and AIDS. Many of the nurses and counsellors I worked with have children in their own families who are HIV positive. The will to protect children is enormous. The simple tools that harness this will are the key to meaningful improvement.

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Elegantly Simple With some coaching, each of these clinic teams began looking for solutions to improve their success at treating eligible pregnant women. Each clinic began a ‘lives saved’ campaign, creating a clinic poster that counts each two lives saved - the child and the mother - for every pregnant woman put on treatment. The practical solutions the teams devised were often elegantly simple. Mbazwana Clinic simply moved its HIV counselling from outside the clinic in a nearby building to a room adjacent to where antenatal care is provided. In one week, the team went from sending blood tests for 20% of pregnant women, to sending 100% of the necessary tests. Mseleni Hospital began to screen women waiting for ultrasound to ensure that all women who had blood drawn for CD4 counts got their results.

From 10% to 80% We are still evaluating the long-term effects of this brief intervention. At Mseleni Hospital, the PMTCT improvement team conducted an audit of their own labour ward. They found that before our collaboration, fewer than 10% of the women presenting for labour had CD4 lab results recorded in their patient-held medical records. Two months after our pilot project concluded, 80% of HIV positive women presenting to the labour ward had received their CD4 lab results. This one blood test determines which women and children stand to gain the most from ARV treatment during pregnancy.

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Using improvement methods developed by IHI, I helped multi-professional teams of clinic and hospital staff to track and evaluate their own success at identifying pregnant women with AIDS and beginning appropriate treatment. I sat down with the nurses and counsellors at each clinic to understand how pregnant women seeking antenatal care move through the clinic sys-

HIV/AIDS office at Mbazwana clinic

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HIV Transmission to Infants The Institute for Healthcare Improvement (IHI) is a US-based NGO that collaborates with the Umkhanyakude Health District and the Centre for Rural Health at the University KwaZulu-Natal (KZN) to improve the widespread distribution of ARV’s in the rural KZN health system. Between June and August of 2007, I worked with the physicians, nurses and HIV/AIDS counsellors at two public hospitals and six clinics to strengthen effective treatment of pregnant women with AIDS in this district. Our goal was to improve efforts to place eligible pregnant women on HAART (Highly Active ART) treatment, in order to prevent the transmission of HIV to their children. The communities served by these facilities are deeply rural and very poor. Unemployment hovers near 70% and more than one of every three pregnant women are HIV positive.

At each site, we held a brief celebration to congratulate the staff on their successes, applauded those who contributed to the change, and asked what more we could do. I helped each team understand its progress in comparison to neighbouring sites and trained site mentors to continue the improvement process and share successful strategies between teams.

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HIV/AIDS treatment has become more commonplace for adults in some areas in South Africa since the Government approved public provision of antiretroviral (ARV) therapies in 2003. Despite uneven progress, the growing local knowledge that desperately ill people can recover rapidly after receiving treatment has created an enormous demand for antiretrovirals. In contrast, effective treatment for HIV-positive pregnant women during their pregnancies remains a rarity. The system designed to prevent mother-tochild transmission of HIV has lagged far behind gains in treating non-pregnant adults living with AIDS.

Jessica Greenberg / MD Candidate, 2010, Harvard Medical School, United States of America Email: jgreenberg@hms.harvard.edu

IMPROVING HEALTH INDIGENOUS HEALTH

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Traditional Medicine Mapped The phenomenon of globalisation causes an increasing mobility of populations from many parts of the world, from Asia in particular, all having different cultural traditions. While generally regarded as a wealth for the receiving communities, cultural differences may limit and cause inequalities in effective healthcare delivery. Therefore, it is important to understand the patients’ cultural backgrounds and their behaviour in relation to symptoms and ill health for a more effective communication between health professionals and patients, for a better comprehension of their health problems, and higher quality care.

utilised to comprehend and systematise this data; • a virtual platform and a network of local institutions to collect, systematise and exchange the multilingual information that was generated by the research.

The Centre for Training and Research in Public Health of the Sicilian Region (CEFPAS) promoted a three-year study on traditional medicine in six European and Asian countries (Italy, Greece, India, Nepal, the Philippines and Thailand) to study and map a number of symptoms interpretations, remedies adopted by the populations, perceived efficacy of the selected treatment, and its possible side effects and cost. The five symptoms selected were: diarrhoea, fever, headache, joint pains and spontaneous abortion. The ensuing analytical maps were made accessible to professionals world-wide through the innovative application of ICT instruments. The information is useful to better understand patients from different cultural backgrounds, make quicker and more precise diagnoses and offer more cost-effective and better clinical and human care. The project was financed by the European Union.

Main Studies Three main studies were contemplated by the project: A population study Interviews were conducted with a sample of the general population of the selected field study sites, comprised of men and women of different age groups and urban and rural areas. Sixty individual interviews and five focus groups (one per symptom/illness) were carried out in every country of the project. The collection of data included the population perception of causes of ‘illnesses’, the treatment used, its cost, its perceived effectiveness and any possible side effects.

Tools and Methods The project included: • a series of ethno-anthropological studies on traditional medicines using semistructured questionnaires, open interviews and other quali-quantitative research instruments and ethnographic/comparative approaches for data collection and analysis. Multi-angulation analysis was 20

A horizontal decentralised approach was used among partners, with equal opportunity to share ideas, creativity, resources, responsibilities and results. The relationship was based on professional respect, culturesensitivity, and a constant exchange of views and experiences for individual and group growth.

A healer’s study Five traditional healers were interviewed in each context. The main questions regarded their training, their initiation, the type of remedies they used, their perceived effectiveness and their knowledge of possible negative side effects. They were asked information on the cost of ‘treatments’ and the payment modalities. The PHC doctors study Ten PHC doctors were interviewed in each country. They were asked about their knowledge of the causes of common illnesses that people believe in, on local use of traditional

An interview held in India remedies and on the evidence of their negative side effects. Questions were also asked on the cost per episode of illness in relation to pharmacological treatment. Doctors were also asked about their perceptions and use, if any, of traditional remedies to ‘treat’ the most common illnesses affecting their population. These are some of the most relevant results: • Production and validation of data gathering tools related to the different target groups. The common format was in English; it was adapted to the different cultural contexts and was translated into the six local languages. • A total of 360 interviews to the general population were conducted: additionally five focus group discussions, 50 interviews to PHC doctors, ten to gynaecologists/midwives, 35 to traditional healers, and five to traditional birth attendants. • Creation of a virtual platform using the latest ICT technology that houses the data collected, analyses, maps, and other useful information on the project. Conclusions The knowledge gained through this crosscultural project on traditional medicine across Euro-Asiatic cultures is valuable to health and social care professionals of all continents. The maps on behaviour and practice can guide professionals to better understand the health problems affecting people from different cultures, make a more appropriate and earlier diagnosis, and offer a more effective and efficient clinical and human care quality. Pina Frazzica | Director General CEFPAS, Italy Email: frazzica@cefpas.it

HEALTH PROMOTION

Oral Health Promotion in South Africa

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Project’s Findings • Adolescents who did not live with their mother were more likely not to be brushing regularly. • This study further demonstrated that adolescents with a predisposition to cope adequately with stress and those not smoking were more likely to brush regularly and experienced a good gingival health, irrespective of the level of oral hygiene. • Smoking onset on the other hand, was least likely when youth strongly believe that smoking causes bad breath and that bad breath has negative social consequences, such as peer rejection. • These results supported the implementation and evaluation of an intervention integrating oral health promotion with a social skills-based smoking prevention

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In the initial phase of our project - leading up to an intervention for oral health promo-

This photo was used during the oral health promotion project: “Boy being rejected by a girl as a result of bad breath developed from smoking”

curriculum: the LifeSkills Training (LST). In addition to teaching stress-coping skills, the LST curriculum provided information on short-term health consequences of smoking, focusing on effects such as bad breath and its influence on social interaction, especially as it relates to the adolescents’ romantic aspirations. • A randomised controlled trial showed that after two years, when compared to the usual health education taught in 11 control schools, the LST curriculum taught in ten schools was very effective in promoting adolescents’ regular tooth-brushing behaviour and good gingival (gum) health. • However, the intervention did not significantly reduce smoking prevalence, but increased non-smokers’ cigarette-offer refusal self-efficacy, which may reduce susceptibility to future smoking. • Nevertheless, the LST curriculum also significantly reduced alcohol use among adolescents in schools that received the programme as compared to the control schools. • Future programmes designed to promote healthy behaviours among adolescents should consider ways to enlist the support of the family members, particularly their mothers where possible. • Furthermore, considering that we found that on average only 60% of the curriculum was taught, we would need to investigate how the teachers and students themselves found the curriculum in order to improve the outcomes of the curriculum with regards to smoking prevention.

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Behavioural Risk Factors Bacterial plaque accumulation on teeth that could result from irregular tooth brushing is the main aetiologic agent implicated in periodontal diseases. However, other important risk factors include smoking and stress, both of which are also common risks for cardiovascular diseases. The recognition of these common risk factors - together with the realisation that there are limited resources to run oral health promotion programmes separately from other programmes directed at promoting general health informed the WHO’s resolve in 2007 to formally adopt the integrated approach to oral disease prevention. This public health approach seeks to address modifiable risk factors common to both oral health and general health, but only limited evidence is available on its effectiveness. While the role of oral hygiene and smoking is well documented, there is only limited information on the role of stress in oral health.

tion - we conducted studies to determine predictors of gingivitis among adolescents and to explore the association between attitude to oral health and smoking. Given the existing evidence linking household poverty with stress among adolescents and in line with the salutogenic theory of Antonovsky, we were particularly interested in exploring how rural adolescents’ ability to cope with stress, as measured on a sense of coherence scale, influence their oral health.

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Oral diseases adversely affect overall quality of life, self-esteem and social confidence. Although oral diseases are largely preventable, they still pose a significant burden to many people in marginalised communities, where pain control and dental treatment are still not readily accessible. Of the nine provinces of South Africa, Limpopo Province has the lowest human development index, and the recent national children oral health survey suggests that the adolescents in this province have the highest burden of poor periodontal (gingivitis) health. Gingivitis commonly presents as frequent gum bleeding upon tooth brushing. In addition to the fact that periodontal diseases, if not controlled, could lead to tooth loss, there is also growing evidence that periodontal diseases are a risk factor for pre-term low birth weight and cardiovascular diseases in adulthood.

Bart van den Borne and Olalekan Ayo-Yusuf | Researcher, Associate Professor - PhD Student - Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands Email: b.vdborne@gvo.unimaas.nl

STUDENTS’ COLUMN OUT OF THE SNO PEN

STUDENTS’ SPEAKERS CORNER

Welcome Back Kenya This article was written early 2008.

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Co-facilitaters of the SNO pre-conference workshop HOW TO BECOME AN EFFECTIVE LEADER OF CHANGE As medical students we face the need to identify the main health issues affecting our communities and outline approaches to a solution. In order to accomplish this goal, medical students should have leadership skills. This was a concern for the Student Network Organisation (SNO). Members of the SNO suggested this topic for a pre-conference workshop at the 2008 Network: TUFH Conference in Colombia. We received support from the organisation and many people were involved in this process. John Hamilton was invited to facilitate the workshop. With no doubt, and a lot of enthusiasm, he started to get everything ready. His principal objective was to involve students as much as expert professors in this topic. The SNO pre-conference workshop Student Leadership Development - How to become an effective leader of change? aimed to address strategies of enabling students to gain the skills of leadership for change for the good of patients, communities, healthcare, and health workers. It was co-facilitated by Ian Cameron (University of Newcastle, Australia), Roger Strasser (Northern Ontario School of Medicine, Canada), Dimity Pond (University of Newcastle, Australia), Tarun Sen Gupta (James Cook University, Australia), and Lina Acuña (La Sabana University, Colombia). The student contributors were Job Magire (Moi University, Kenya), Riley Savage (James Cook University, Australia), and Sofia Contreras (La Sabana University, Colombia). During the workshop we had the opportunity to exchange experiences with doctors and other students from different cultures who taught us that creativity, commitment and collaboration are the secrets for success of leadership. We returned home with a little more knowledge, and willingness to be useful to our communities. Sofia Contreras | SNO Secretary General, Colombia Email: raquelcome@unisabana.edu.co 22

A semblance of calm had returned in Kenya, so I decided that it was a good time to travel to Eldoret and find out what our school’s schedule would be, since all I was getting back home was conflicting information. I had to travel because I was expecting an exam in the opening week. All the way across three provinces, the roads were barricaded by youths, demanding money from motorists. We were forced out of the vehicle at three stops to chant anti-Government slogans! In 2007 an orderly election day was followed by a suspiciously long counting period. Many electoral officers had turned off their cell phones or disappeared with the official counts. Some of them waited two days to resurface, with up to 20,000 more votes for the incumbent than observers had recorded. As results trickled in, the opposition’s lead suddenly dwindled from over a million to 40,000 votes. Time accelerated, tension mounted, and confusion gripped the country. One thing grew uncomfortably clear: someone was manipulating the results. Tension steadily cut across the nation, suspicion-driven propaganda took centre stage; rumours flew by text message, radio, television, and word of mouth. As one newswoman put it: “In the old days, at least these things happened behind closed doors. This time they did it right out in front of everyone, then asked us not to notice”. Three days after Kenyans cast their ballots, Mwai Kibaki was announced the winner. Half an hour later he was sworn in before a preassembled crowd of dignitaries. By the time the ceremony was ending, the Ministry of Internal

Security had issued a ban on all live broadcasts, cutting off the opposition’s press conference in mid-sentence. And by then, the slums began to burn; countrywide riots were mounted. The efforts to salvage the country started. In the nick of time, the internationally pressured negotiations succeeded, resulting in the formation of a coalition Government. This was the deal everyone had been waiting for: to seal political peace and restore ‘normalcy’. Now the politicians are back to the city; and the poor Kenyans? Many are still languishing in displacement camps; children in many areas have no school to go to because many schools were looted and burnt; the health centre is no more. The divide between poor and rich is even wider now. It continues to breed dissention and hopelessness since the people are acutely aware that their life is not as it ought to be, not as good as that of people in the city a few miles away. Many Kenyans are too poor to have a decent life, and too disillusioned to believe the situation will improve in their lifetimes. Nevertheless, welcome back Kenya, and as Kofi Annan succinctly stated: “The job of national reconciliation and reconstruction … must be carried out in every neighbourhood, village, and hamlet of the nation”. God bless Kenya, and we need a paradigm shift. Job Siekei Mogire, SNO Chairperson Email: jobsm2005@yahoo.com

STUDENT INTERVIEW How do students from all over the world perceive the educational programme at their Faculty, or the educational system in their country? How do they see the future, for their nation and for themselves? And what changes would they make, if they had the chance? We wanted to know. Therefore, in every Newsletter December edition we ask a student five questions.

The Big Five This interview was conducted with Dima Jarrar, sixth-year medical student at the Faculty of Medicine, University of Jordan, Jordan.

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Imagine if you were to choose: a practice in a town or in a rural area. What would you choose and why? It is harder to work in a rural area, of course. I think for that I need to be more experienced, so that I can deal with the limited resources. Therefore, I prefer to start my working carrier in our capital, Amman. Later on, I can go and work in rural areas. They have a right to good, efficient and accessible service, as they are also a part of the Jordanian community. It does not mean that because they live in rural areas, they must be ignored. I would see it as part of my national, professional and ethical duty to support them, as they are usually the people who need our help the most.

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Being a Minister of Education would be very challenging! I would change the criteria for entering medical school. Now it depends on your grades in high school. But I do not think grades reflect how good a doctor you can be. I think it should be based more on your interests; your interest in medicine says more than just good grades.

cine was just not their main interest. Therefore, I think students should be interviewed about their motivation, and this interview should be given a high margin in the selection process.

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What would you change if you were Dean of your Faculty? Or on a national level if you were Minister of Education in your country? During rotations we have our own patients. We take care of them and we take their history, but the patients do not depend on our examination and examination results, as the diagnosis has already been made. As Dean I would prefer to let the students be part of the team, and not only be the observers. Let them be part of the diagnosis, and of setting the therapy. By giving them the space to contribute, they can feel the pressure and responsibility, which will make them better and more efficient doctors.

Ms. Dima Jarrar

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Can you as a student influence the educational programme of your Faculty? Yes, we have some influence. By the end of the year, we can give our opinion about rotations and doctors through a survey. Resulting improvements are applied during the years after us, so the students that follow us will benefit from it. This method ensures continued progress to reach higher and better levels of medical education. We also have conferences with the Dean; once a year he invites us to discuss matters that are important to us and to the Faculty.

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Why did you choose to study Medicine? My father is a doctor (Senior Consultant Audiologist); through him I became interested in medical issues. But also, I always wanted to be helpful to my community, and specifically to its sick people.

What is your opinion about innovative education formats? When I started, the integrated programme was applied. Before that time, they studied all the basic sciences individually, but we studied systems. For example when we study the cardiovascular system, we learn the pharmacology of it, the biochemistry about it, et cetera. I think it is better than studying everything separately; it helps in the clinical years. We were also the first year to use the skills training laboratory. It is very helpful, but unfortunately it is not always available to us, because we have to be under supervision when using it.

We started in the first year with approximately 300 students; through the years we lost 120 of them, mostly because medi23

MEMBER AND ORGANISATIONAL NEWS ABOUT OUR MEMBERS

Experiences in the Eastern Mediterranean Region

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To stay more connected with The Network: TUFH between our annual conferences, we encourage our members to use email and Internet links to make contacts directly with other member institutions (see: www.the-networktufh.org/publications_ resources/interactive.asp). The Executive Committee (EC) has suggested increasing interaction between the EC and the Network: TUFH membership in their specific region. Regional discussion lists, which will give the EC (and vice versa) the opportunity to communicate directly via email with the membership in their specific region, have been created to facilitate communication. One of the discussion lists that have been created is the Eastern Mediterranean Region (EMR) discussion list (network-em@ nic.surfnet.nl - for subscription, unsubscription, list-archives, you can visit the lists homepage: http://nic.surfnet.nl/archives/ network-em.html). Through this discussion list, Ghanim Alsheikh (Regional Adviser, Human Resources Development, WHO, Eastern Mediterranean Regional Office) asked an interesting question: dissemination of the wave of innovation mostly took place during the 1980s, but how many of the present medical schools in the EMR are adopting innovative programmes? To find out Alsheikh called upon all to exchange opinions and experiences that could result in useful recommendations and action plans. In support of the above, the Newsletter wants to start a column in which everyone can present their EMR experiences. We start the column with some of the first reactions to Ghanim Alsheikh’s appeal.

REGARDING THE CURRICULUM, THE COLLEGE DEVELOPED ITS OWN HYBRID CURRICULUM. Nighat Huda | Professor of Medical Education, Controller of Examination, Department of Medical Education and Examination, Ziauddin Medical University, Pakistan: Dear friends, I would like to share with you information about Ziauddin Medical College, affiliated to Ziauddin University. In 1996, since its inception, the Medical College initiated an innovative programme with the objective that the graduates produced will have better understanding of the context that they are going to practice, and self learning skills to face the challenge of exponential growth of knowledge. As a result, a partnership was developed with the adjoining community, and the University assumed responsibility of a population of 20000. PHC was established with seed money from the University. The Family Medicine Department runs the PHC and other community-based activities. A committee comprising of community elders, counsellors, et cetera runs the activities including financial management. The site is used for under and post graduate training. An integral part of the curricula is family attachment in which undergraduate medical students are attached to two to four families for two years. Both Departments of Family Medicine and Community Health Sciences are responsible for education, research and service.

Regarding the curriculum, the College developed its own hybrid curriculum. In the first three years an integrated curriculum was introduced, with PBL being the major strategy. Initially, PBL was started in the first three years and now it is also implemented in the fourth year. Seven cohorts have graduated from this system. Graduates strongly favour PBL. The curriculum is reviewed yearly and necessary changes are made. With regards to assessment, two major decisions were taken: a centralised Department of Examination was established, and students’ result was notified as ‘satisfactory’ and ‘unsatisfactory’. Again, for those interested in this design, the process could be shared. Unfortunately, the summative examinations could not be changed to integrated, due to the requirements of the regulatory body of subject-based assessment. The entire model has been developed within the entire budget with no dependency on funding, either from national or international institutions. I will be glad to respond to your queries pertaining to the information provided. Thanks!

WHY ARE WE SO LATE IN THE REGION TO ADAPT INNOVATION IN OUR MEDICAL SCHOOLS, THOUGH WE STARTED EARLY IN THIS DIRECTION?

Fathi Maklady | Vice President for post-graduate and research, Suez Canal University, Egypt: Dear Dr Ghanim, You raised the very important question and also concern - why we are so late in the region to adapt innovation in our medical schools, though we started early in this direction (not only that, but we contributed in the wave of innovation world-wide, mainly Suez Canal and Gazeira medical schools).

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Again, I think it is an important issue you raised. It may be worth a round table discussion to come out with practical recommendations.

• I agree with you that we are still having the ‘top to bottom’ culture, even in our innovative schools. However, I hope that some of the graduates will change that in future, with more democratisation all over the area.

INTERESTING INTERNET SITES The Network: TUFH Interactive Recommended websites www.the-networktufh.org/publications_resources/interactive.asp The World Health Report 2008: Primary Health Care www.who.int/whr/2008/whr08_en.pdf WHO Global Atlas of the Health Workforce www.who.int/globalatlas/default.asp The Concept of Prevention: A Good Idea Gone Astray? jech.bmj.com/cgi/content/full/62/7/580 Reducing Health Care Costs trough Prevention (Prevention Institute) www.preventioninstitute.org/documents/ HE_HealthCareReformPolicyDraft_091507.pdf

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• The resistance from the medical staff. This can be overcome by three steps: awareness - sharing - commitment.

• I believe that sustainable training and workshops would yield change in the long run. Therefore, I assume the many workshops and courses that were conducted throughout the previous two decades resulted in the current changes in the region. However, they are not meeting our hopes yet.

NEW MEMBERS Individual Members • Dr. Abraham Joseph, Institute of Public Health Bangalore, Vellore, India; • Dr. Beatriz Almeida De Frenk Manuel, Faculty of Medicine, Edwardo Mondiale University, Maputo, Mozambique; • Dr. Judi Gravdal, Rosalind Franklin University/Chicago Medical School, Advocate Lutheran General Hospital, Park Ridge, IL, United States of America.

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• The commitment of the medical school’s leadership. When the Dean and his associate were convinced of - and dedicated to - innovation, there were a substantial number of changes in that direction. Unfortunately, the system collapsed in some of those schools after the leadership left, because of the lack of institutionalisation of the system.

Amany Refaat | Professor, Department of Community Medicine, Faculty of Medicine, Suez Canal University, Egypt: Dear Profs. Fathi and Ghanem, Allow me to be optimistic - as usual - and look at the glass as half full. Let me summarise my point of view as followed: • The number of innovative health professional educational institutions is increasing all over the world; however, the majority of these are the newly established ones. I am sure that the numbers in the EMR increased as well. If we kept our expectation of radical changes to old schools, we will be truly disappointed.

It is with pleasure that we would like to inform you that the following Full Member has been awarded (a continuation of its) Full Membership: Up to 2013: Master of Health Professions Education, Maastricht University, Maastricht, the Netherlands. Bronze Full Member

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In my opinion there are three main reasons: • The lack of the political commitment at the level of the Ministry of Higher Education. We at Suez Canal University fought to spread the idea: tens of workshops and site visits et cetera, with little success. Five years ago, the Government wanted to innovate higher education in Egypt through its national project; there is now a strong movement, and also achievements as revising curricula, improving teaching skills, changing student assessment, programme evaluation, and working hard towards accreditation according to international and regional standards (I should not undermine here the efforts done by WHO in that respect).

I BELIEVE THAT SUSTAINABLE TRAINING AND WORKSHOPS WOULD YIELD CHANGE IN THE LONG RUN.

MEMBER AND ORGANISATIONAL NEWS ABOUT OUR MEMBERS

TASKFORCES

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Family Medicine and Primary Healthcare in Africa

• Primafamed is a two-year project with a mission to improve the health of the population of Africa and to reach equity in healthcare delivery by strengthening community-oriented primary healthcare. Primafamed is coordinated from Ghent University and tries to support African universities in their efforts to establish and improve primary healthcare education. More information can be found at the website: www.primafamed.ugent.be Key activities include: - In July 2008, a meeting was held between Primafamed and the two partner universities in Sudan to establish family medicine training. Gezira University has developed a one-year family medicine training programme that started in August 2008. Ahfad University is working on a four-year family medicine curriculum with the Arab Board of Medicine to be initiated in December 2008. - Primafamed also organised a conference in Uganda (17-21 November, 2008) to share experiences, ideas, knowledge and skills on training African family physicians. - During the Primafamed conference, the African Journal of Primary Health Care and Family Medicine was launched. This open access journal serves as a repository for cuttingedge, peer-reviewed research in all fields of primary healthcare and family medicine (PHCFM) in a uniquely African context. Encouraging scholarly exchange between family medicine and primary healthcare researchers and practitioners across Africa, PHCFM provides a contextual and holistic view of fami-

ly medicine as practised across the continent. The journal is available online at www.phcfm.org - The Flemish Government and Primafamed have been key supports in the process of Defining Family Medicine in Africa. Networking and communication is a key project outcome. Therefore a Google Group has been started (http://groups.google.com/ group/african-family-medicine). It provides an opportunity to network across Africa in a closed forum, communicate and shape key issues in these developments. - The Network: TUFH has become a member of the International Interdisciplinary Advisory Board of Primafamed. Dr. Bishan Swarup Garg (member of the Network: TUFH Executive Committee) will be the representative. • The WONCA Africa Regional Conference is planned for 25-28 October 2009, in Johannesburg, South Africa: Family Medicine in the African Context.

INTERPROFESSIONAL EDUCATION TASKFORCE: AN UPDATE There seems to be a resurgence of interest in IPE internationally this year as more countries grapple with: • an increasing ageing population; • a decreasing youth to take up traditional healthcare professional education and positions; • the 70% shortage internationally of health professionals which is becoming more apparent; • the brain-drain from developing countries to westernised countries which continues; • the focus on prevention, primary and community care which continues. Health professionals are now being educated to work more flexible hours, and encouraged not to think they will be operating in the same profession for the rest of their lives (as was once the case). The way in which healthcare personnel are educated is constantly under review. In the UK now the professional bodies require a proportion of the curriculum to be multiprofessional, and often this means interprofessional. Changes in legislation in Canada have meant that litigation is not just the concern of those medically qualified, and that the leader - or the person responsible within the interprofessional team - is legally responsible. The All Together Better Health Conference held in Stockholm this year was attended by over 300 people interested in IPE developments internationally, and the collaboration between the IPE networks continues to grow. The World Health Organization will launch their Framework for Action of Inter-professional Collaboration and Practice. I hope this stimulates colleagues into thinking through other ways in which we can encourage the sharing of good practice in IPE. Dawn Forman | Chair of the taskforce IPE Email: dawn.forman@btinternet.com

Taskforce Care for the Elderly Gets New Chair At the last Network: TUFH Conference in Colombia, I volunteered to become the Chairperson for the taskforce Care for the Elderly. I guess you are interested in getting to know me, just as I would like to get to know everyone. So who am I?

All this we hope to do for the future, in order to contribute to the care of the elderly and make their lives more comfortable and fulfilling.

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Noeline Nakasujja | Chair of the taskforce Care for the Elderly Email: drnoeline@yahoo.com

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Future Plans The future of the taskforce will depend on the many ideas that have been floated by the taskforce members, with me as the Chair to drive the process.

tings as may be appropriate, and lastly, the use of the World Health Organization toolkit as an instrument in helping to ensure that service is delivered to the elderly at primary health centres.

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Special Vulnerable Group The elderly as individuals face many challenges world-wide and so do the few health professionals who try to provide services for them. With the inversion of the population pyramids in many countries, special services have to be instituted for the elderly. Coupled with this reality is the fact that as we grow older we have a multitude of complications with aging, like failing physical health, decreased social networks and a vulnerability to physical and psychiatric complications.

In a number of countries, the services for the elderly are often inadequate or are expensive and lack coordination for them to be effective to the larger target group, with only a few able to access them. Indeed, the elderly are often neglected in services provided for the eneral population; therefore, an effort has to actively be made to reach this special vulnerable group.

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I have served as secretary to the Association of Uganda Women doctors, am a member of a number of scientific associations including the International Psycho Geriatrics Association and the Social Accountability taskforce of The Network: TUFH. I also serve as a member on the Young Psychiatrists Council for the World Psychiatric Association.

A Bogotรก health centre which caters for the elderly community

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My research interests include geriatric psychiatry and cognitive impairment in HIV/ AIDS. I received my medical degree, as well as my Masters degree in Psychiatry, at Makerere University Medical School. Currently I am on a collaborative PhD programme between Karolinska Institute, Sweden and Makerere University.

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Who am I? I am the new Chairperson for the taskforce Care for the Elderly, but this you already know! I am a Psychiatrist and Senior Lecturer in the Department of Psychiatry at the College of Health Sciences, Makerere University, Uganda. I am also the Head of the Clinical Services in the Psychiatric Department of Mulago National referral hospital.

I am very grateful for the responses I have received from members and I would like to summarise future plans. The aims and objectives of the taskforce will have to be evaluated to reflect its activities. There is much we can learn from other taskforces, like the development of learning modules for interprofessionals as well as specific groups. The development of small recreational programmes for the elderly in different set27

MEMBER AND ORGANISATIONAL NEWS TASKFORCES

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Introducing the Taskforce Social Accountability and Accreditation The taskforce on Social Accountability and Accreditation (TSAA) held its formal inauth gural meeting on September 30 , 2008 in conjunction with the Network: TUFH Conference in Bogotá, Colombia. Building upon the insights and enthusiasm gained over two workshops in Ghent and Kampala, we were fortunate to have the support of the Network: TUFH Executive Committee in formally establishing the taskforce and developing an electronic forum for the enthusiastic group of colleagues. These colleagues met last year and established a rough work plan to advance the potential for accreditation systems to reflect and enhance the principles of The Network: TUFH and its constituent members. A number of interrelated issues include: • building on World Federation for Medical Education (WFME) and other standards and modifying them to more closely reflect social accountability; • defining the nature of the standards, evaluation of compliance and consequences of non-compliance in the varied international context for accreditation systems; • assessing the current state of affairs; • preparing of pilot initiatives for implementation; • ensuring a focus on ‘equity’ and other SA values in the standards and their use; • including premedical school preparation and admissions processes in the scope of the standards; • distinguishing between ‘social responsiveness’, ‘social responsibility’ and ‘social accountability’; • distinguishing between ‘policing’, ‘enabling’ and ‘quality assurance’ in the role of systems of accreditation. The Working Groups that were established in Kampala (Literature review, Survey/ Needs assessment, and White paper) have 28

made some progress in the interval. Recruitment continues in the needs assessment study and interested parties are encouraged to contact the Principal Investigator (shafik.dharamsi@familymed.ubc.ca) to explore enrolment of their site in the study. A paper outlining the relationships and opportunities for bringing together accreditation activities and those related to social accountability is in the final stages of preparation. The bulk of the Bogotá Conference was given over to exploring in some detail our potential approach to analysing and modifying the WFME standards. A subcommittee has agreed to review the WFME standards in their entirety and draft suggested modifications. Thereafter, this work can be taken forward into a number of venues where taskforce members are active: • Charles Boelen is working with a new network of schools focused on SA. This has created an opportunity to discuss potential pilot institutions for the standards. • The WHO has planned a meeting in Geneva in February 2009 to launch an initiative in Quality Assurance and Accreditation. While this does not specifically address social accountability, Charles Boelen is engaged in the planning and process. • The Association of Faculties of Medicine of Canada has received federal funding for the next phase of their initiative in social accountability and has convened a planning group of academic leaders. • Taskforce member Moses Galukande of Uganda has been leading the development of an accreditation system there based on modified WFME standards reflecting social accountability principles. • An international consortium of medical schools is working with Nepalese col-

leagues to support the development of the Patan Academy of Health Sciences, a new distributed and community-based institution explicitly based on social accountability principles and processes. It has received parliamentary approval and seed funding from the new Government. • The LCME/CACMS accreditation system for North American medical schools (148) has established new standards in the realms of ‘service learning’ and the climate of a medical school that are direct expressions of social accountability expectations. The LCME has expressed an interest in working on broader issues of SA. • Bob Woollard, Jan de Maeseneer and others have been working in East Africa on the development of accreditation systems across disciplines and along the spectrum of life long learning. There are undoubtedly many additional activities and opportunities that can be brought forward, and taskforce members are encouraged to report any efforts of which they are aware. It is evident that a number of international trends make the existence of the TSAA very timely. If we are fortunate enough to ‘catch this wave’, we will be well positioned to make major contributions to the development of global medical education. We will be following up this report with the draft standards for your review and ratification. In the interval, your counsel, advice and work are welcome as we move forward into a new world of opportunities. Robert Woollard and Charles Boelen | Chairs of the taskforce Social Accountability and Accreditation Email: woollard@familymed.ubc.ca; boelen.charles@wanadoo.fr

REPRESENTED AT INTERNATIONAL MEETINGS/CONFERENCES The Network: TUFH is being represented at meetings and conferences all over the world. Here is a report of one of our representatives.

Expanding Horizons in Medical Education

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International collaboration for medical education Effective inter-institutional collaboration requires transparency, trust and professionalism in reaching mutual understand-

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Individual core competencies include: cross cultural competence competence, especially communication skills; understanding the geographic burden of disease; using minimal resources to solve clinical problems; awareness of social and environmental determinants of health, as well as health inequities; teamwork and collaborative problem solving; professionalism and ethical behaviour; consideration of personal living and health requirements for global health workers. Community core competencies include: conducting a limited, population- or communitybased study; applying knowledge of preventive care; understanding impact of migration, movement and marginalisation on health; understanding various global health players.

Information technology (IT) in GHME This topic was scheduled, but discussed only to a limited extent. However, the following summary is offered as a basis for further discussion. A basic problem has been to clearly define the educational value and use of IT in medical education, which potentially includes three functions: communication, data access, and active learning using a computer or other communication tool that can access the Internet. Whereas communication and data access is self explanatory and limited only by the rate of expansion of communications and computer technology, by contrast using the computer to learn - which will undoubtedly increase in the future - is a new educational domain that is not well understood. Computer-based learning strategies should be accompanied by careful, ongoing evaluation of technical and human engineering factors, as well as learner achievement, before being introduced generally. Successful use of IT may increase educational capacity in resource poor countries and strengthen intern institutional collaboration.

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Criteria for choosing international placements A wide variety of experience has accumulated with medical students studying at international sites. Placements must deal effectively with the following areas: establishing

Core competencies in global health and medicine education (GHME) While core competencies should apply across sites anywhere in the world, for students from southern as well as northern countries, another set of competencies should be defined that are tailored to each specific site. Although a few of the following competencies (e.g. teamwork) may be included in a given school’s curriculum unrelated to GHM, it was included in case they are not already part of a given curriculum.

ing regarding commitment to a long-term institutional partnership that includes educational, research and other activities. This understanding must extend to a preliminary mapping out of governance, administration, roles and responsibilities and evaluation of the collaboration.

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The following five topics were discussed in depth: The meaning and scope of global health and medicine (GHM) The consensus was that medical students should study GHM, preferably when they live in an unfamiliar culture, in order to provide them with a personal, emotional, and professional experience not otherwise available. This training will sensitise them to other cultures, enable liaisons with medical students from these cultures, and offer first hand knowledge of community and individual GH problems and of ways to manage them.

inter-institutional understanding between the local and distant institutions; defining a structured educational programme, with appropriate local and distant supervision and evaluation; medical and personal safety; logistical and administrative arrangements, including travel, room and board.

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Expanding Horizons in Medical Education: Global Health Education for all Medical Students, Bellagio-Italy, September 2008 Seventeen participants from various parts of the globe met in Bellagio, Italy in September 2008, at the invitation of Ben Gurian University. The topic of the conference was Expanding Horizons in Medical Education: Global Health Education for all Medical Students. This theme is central to the Network: TUFH’s activities and it will be good if our next Conference in Jordan can have a session on this topic. The aim of the Bellagio conference was to suggest guidelines for teaching and learning global health in medical schools. At the end, there was a consensus that global health gets done properly only in a multidisciplinary fashion and that a critical next step is a conference on the planning of effective multidisciplinary global health education.

The Network: TUFH is being represented at meetings and conferences all over the world: • WHO Regional Committee for the Western Pacific, September 2008, the Philippines. Represented by Noel Juban. • Bellagio Conference on Expanding Horizons in Medical Education: Global Health Education for all Medical Students, September 2008, Italy. Represented by Abraham Joseph. st • 124 WHO Executive Board Meeting, January 2009, Switzerland. Represented by Pertti Kekki.

Abraham Joseph / Past Chairman of The Network: TUFH Email: abrahamjosepha@gmail.com 29

MEMBER AND ORGANISATIONAL NEWS INTRODUCING MEMBERS

Northern Ontario School of Medicine

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The Northern Ontario School of Medicine (NOSM) in Canada is a pioneering Faculty of Medicine. For the whole of Northern Ontario, the School is a joint initiative between Lakehead University and Laurentian University, with main campuses in Thunder Bay and Sudbury, and multiple teaching and research sites distributed across Northern Ontario. A medical school like no other, NOSM has a strong emphasis on the special features of Northern Ontario. These include: a diversity of cultures and geographical locations; varying illness, injury and health status patterns with their specific clinical challenges; a wide range of health service delivery models which emphasize supporting local healthcare and interdisciplinary teamwork; and the personal and professional challenges, rewards and satisfactions of medical practice in Northern and rural environments. NOSM is the first Canadian medical school established with a mandate to be socially accountable to the cultural diversity of the region it serves, including: Aboriginals, Francophones, remote communities, small rural towns, large rural communities and urban centres. Evidence of this mandate can be found in the School’s curriculum, administrative structure, research programme, student demographics, continuing professional education programme, and more (see www. nosm.ca). Our Vision and Mission NOSM is a pioneering Faculty of Medicine working to the highest international standards. Its overall mission is to educate skilled physicians and undertake health research suited to community needs. In fulfilling this mission NOSM will become a cornerstone of community healthcare in Northern Ontario. Our Students NOSM will seek out qualified students who have a passion for living in, working in and 30

serving Northern and rural communities. NOSM will train physicians able to practice and engage in research anywhere in the world, but who have a particular understanding of people in Northern and remote settings. Innovation NOSM faculty, staff, and students do not function in a traditional medical school building. Rather, the walls of the School are the boundaries of Northern Ontario, and at any given time an individual may be working at one of the School’s two campuses, or in a remote rural or urban community. One of the most important innovations to date has been on the distributed communityengaged education front. In their first year, all students (in pairs) spend four weeks living and learning in an Aboriginal community (Module 106). In the second year, they do the same for eight weeks in remote and rural communities (Modules 108 and 110), and they spend the entire third year in a Comprehensive Community Clerkship (CCC) within a large rural or smaller urban centre. In these centres, Local NOSM Groups (LNGs) have been created, made up of local educators and community volunteers, to ensure local representation within the School, and to facilitate the smooth integration of medical students into communities by means of orientation programmes and introductions to community members. The third-year students acquire practical, patient-centred learning through the CCC prior to completing their studies in the Regional Academic Health Centres in Sudbury and Thunder Bay. As the School continues to evolve, more LNGs will be included in a progressively expanding network of relationships, thus fulfilling NOSM’s commitment to build partnerships with communities and health organisations across all of Northern Ontario.

Over 70 distributed communityengaged learning sites The LNGs also provide a mechanism for both an individual community and the School to stay abreast of each other’s respective developments. Membership of the LNGs varies, depending on the need and desire of each community. Generally, membership includes broad representation from faculty, community leaders, individuals, and local healthcare professionals. Groups meet on a regular basis and discuss such issues as: recruitment, retention, showcasing the community, travel, support for NOSM students, linguistic and cultural issues, and any other issue the Group feels is of importance to both NOSM and its community. While the School has two main campuses in Sudbury and Thunder Bay, we see the whole of Northern Ontario as the true campus of the school. The map shows all the communities in Northern Ontario where our undergraduate and postgraduate learners undertake part of their training. Social accountability to these engaged communities remains foremost in our strategic plan. Marc Blayney | Vice Dean, Department of Professional Activities, Northern Ontario School of Medicine, Canada Email: marc.blayney@normed.ca

INTERNATIONAL DIARY

Diary 2009 1 - 4 March, 2009, Johannesburg, Republic of South Africa Wonca African Regional Conference Family Medicine in the African Context. Organised by World Organization of Family Doctors (WONCA). Further information: Internet: www.globalfamilydoctor.com/ conferences/conferences.asp

Post-Conference Excursion: October 16, 2009: Mu’tah University, Karak, Jordan

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Further information: Network: TUFH Office, P.O. Box 616, 6200 MD Maastricht, the Netherlands; tel: 31-43-3885638; fax: 31-43-3885639; email: secretariat@network.unimaas.nl; Internet: www.the-networktufh.org/conference

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15 - 26 June, 2009, Maastricht, the Netherlands Summer Course: Expanding Horizons in Problem-based Learning in Medicine, Health and Behavioural Sciences. Organised by School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. Further information: School of Health Professions Education, P.O. Box 616, 6200 MD Maastricht, the Netherlands; tel: 31-43-3885611; fax: 31-43-3885639; email: she@oifdg.unimaas.nl; Internet: www.she.unimaas.nl

International Conference on Achieving Quality in Health Care: Challenges for Education, Research and Service Delivery Delivery. Organised by The Network: TUFH and the Faculty of Medicine, University of Jordan.

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5 - 8 June, 2009, Hong Kong, China Wonca Asia Pacific Regional Conference Building Bridges. Organised by World Organization of Family Doctors (WONCA). Further information: Internet: www.wonca2009.org

Annual International Conference of The Network: TUFH 10 - 15 October, 2009, Amman, Jordan

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3 - 4 April, 2009, Padua, Italy International Conference on Equal Opportunities for Health - Action for Development: A plan of Action to Advocate and Teach Global Health. Organised in the framework of the EU Project ‘Equal Opportunities for Health: Action for Development’, implemented by Doctors with Africa Cuamm in collaboration with 29 partners and associates from the health community. Further information: email: s.foresi@cuamm.org; Internet: www.mediciconlafrica.org/globalhealth

25 - 29 May, 2009, Washington DC, USA Global Health Conference. Organised by the Global Health Council. Further information: email: conference@globalhealth.org; Internet: www.globalhealth.org/conference

16 - 19 September, 2009, Basel, Switzerland Wonca Europe 2009 - The Fascination of Complexity: Dealing with Individuals in a Field of Uncertainty. Organised by Swiss Society of General Medicine, World Organization of Family Doctors (WONCA). Further information: email: a.studer@ schlegelhealth.ch; Internet: www.congressinfo.ch/wonca2009/home.php

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26 - 27 March, 2009, Maastricht, the Netherlands Visitors Workshop: A Primer on the Maastricht Approach to Medical Education. Organised by School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. Further information: School of Health Professions Education, P.O. Box 616, 6200 MD Maastricht, the Netherlands; tel: 31-433885611; fax: 31-43-3885639; email: she@oifdg.unimaas.nl; Internet: www.she.unimaas.nl

20 - 22 May, 2009, Halifax, Canada International Conference on Collaborating Across Borders II - Building Bridges between Interprofessional Education and Practice. Organised by Dalhousie University, Halifax, Canada. Further information: email: joan.sargeant@dal.ca; Internet: www.cabhalifax2009.dal.ca

29 August - 2 September, 2009, Malaga, Spain AMEE Conference. Organised by the International Association for Medical Education (AMEE). Further information: email: amee@dundee.ac.uk; Internet: www.amee.org

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15 - 19 March, 2009, Ismailia, Egypt rd 23 International Workshop on Community-based Education Incorporating Problembased Learning, Innovative Approaches. Organised by Center for Research & Development in medical education & health services, Faculty of Medicine, Suez Canal University (FOM/SCU), Ismailia, Egypt. Further information: email: CRDMED@ismailia.ie-eg.com; Internet: crdmed. tripod.com

4 - 5 April, 2009, Seattle WA, USA th 18 Annual GHEC Conference - Transcending Global Health Barriers: Education and Action. Organised by Global Health Education Consortium (GHEC) in cooperation with University of Washington, Seattle WA, USA. Further information: Internet: www.globalhealthedu.org

It is possible to add events to this International Diary from behind your computer. Information inserted in our website database (www.the-networktufh.org) (www.the-networktufh.org) www.the-networktufh.org will be automatically included in the International Diary of the Network: TUFH Newsletter. 31

MEMBER AND ORGANISATIONAL NEWS

THE NETWORK TOWARDS UNITY FOR HEALTH

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ABOUT OUR MEMBERS

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Newsletter Volume 27 | no. 2 | December 2008 ISSN 1571-9308

* The Faculty of Medicine, Universidad Mayor de San Simón (Cochabamba, Bolivia) has awarded our Secretary General Jan de Maeseneer with a Doctor Honoris Causa. This degree recognises of the prominent work he has done in their institution as a professional, teacher and researcher, cooperating to improve development and health in Cochabamba.

Editors: Marion Stijnen and Pauline Vluggen

The cooperation between Ghent University (Jan de Maeseneer works at its Faculty of Medicine and Primary Health Care) and Universidad Mayor de San Simón started in 1997, with an exchange of students: Ghent University students performed clerkships in different environments in Bolivia (especially in primary healthcare), and Bolivian students participated in clerkships in Belgium. Already in the first encounters, there was a clear focus on primary healthcare and family medicine. In 2006 - thanks to a grant from the Belgian Province of Oost-Vlaanderen and the city of Ghent - the construction of the community health centre Nueva Gante in the neighbourhood of San Miguel Pampas was started. Initially, the centre was a service of primary healthcare delivery. The concern was to make the centre accessible, especially for those most in need in the community of San Miguel Pampas. A second role of the centre was its function as a ‘training centre’, not only for residents in family medicine, but also in other disciplines. A third important aspect was that this health centre wanted to function as a kind of ‘laboratory’ for new orientations in primary healthcare delivery. The special focus is here on the participation of the local population in a ‘community-oriented primary care’ process. Recently the centre became fully operational. This is an important achievement, because it sets the agenda for the develop-

Language editor: Sandra McCollum The Network: Towards Unity for Health Publications P.O. Box 616, 6200 MD Maastricht

ment of family medicine training in the context of primary healthcare.

The Netherlands Tel: 31-43-3885633, Fax: 31-43-3885639 Email: secretariat@network.unimaas.nl

* March 16, 2008 was a milestone in the history of the Aga Khan University (Karachi, Pakistan). On that day, 25 years ago, the University received its Charter as a private, international university. In a short period, Aga Khan University has established a reputation for excellence and moved towards accomplishing its vision of impacting and improving the lives of many. In just 25 years, the University expanded its academic programmes to 11 teaching sites in eight countries: Pakistan, Kenya, Tanzania, Uganda, UK, Afghanistan, Egypt and Syria - representing a diversity of cultures and creeds.

www.the-networktufh.org Lay-out: Graphic Design Agency Emilio Perez Print: Drukkerij Gijsemberg

MOVING ON: CHANGES IN INSTITUTIONAL LEADERSHIP The Secretariat received information about changes in leadership with the following Network: TUFH members. We have listed the names of the former and new (Vice-) Deans/ Directors for you: • Dr. P. Narang, Mahatma Gandhi Institute of Medical Sciences, Wardha, India has been replaced by Dr. Shakuntala Chhabra (chhabra_s@rediffmail.com); • Dr. Abraham Joseph, Schieffelin Institute of Health Research and Leprosy Centre, Karigiri, India has been replaced by Dr. Mannam Ebenezer (karigiri@vsnl.com); • Dr. Abdel Salam Saleh, Ahfad University for Women, Omdurman, Sudan has been replaced by Dr. Khalid Fadlalla Badr el Din (bader_1942@yahoo.com).

Ground breaking of Aga Khan Hospital and Medical College by His Highness the Aga Khan