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   Table of Contents - Current issue
September-December 2019
Volume 32 | Issue 3
Page Nos. 111-153

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EDITORIAL  

Co-editors' notes p. 111
Danette McKinley, Maaike Flinkenflögel, Michael Glasser
DOI:10.4103/efh.EfH_88_20  PMID:32317413
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TRIBUTE Top

Reviewers of Education for Health p. 113
Michael Glasser, Danette McKinley, Maaike Flinkenflögel, Payal Bansal
DOI:10.4103/efh.EfH_89_20  
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TUFH 40TH ANNIVERSARY SPECIAL PAPERS: GUEST EDITORIAL Top

Best of Projects That Work p. 114
Ralf Rundgren Graves
DOI:10.4103/efh.EfH_90_20  PMID:32317415
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ORIGINAL RESEARCH ARTICLE Top

Flipped classroom – An innovative teaching model to train undergraduate medical students in community medicine Highly accessed article p. 116
Rupali Vishal Sabale, Padmaja Chowdary
DOI:10.4103/efh.EfH_116_18  PMID:32317416
Background: Second-year MBBS students need to be trained in applying theoretical knowledge into practice so that they can give appropriate advice during family visits in the community. For this, it is necessary to utilize the classroom timing for discussion and facilitation. In “flipped classrooms,” what is normally done in class and what is normally done as homework is switched or flipped. Thus, a study was planned to train the students to apply theory into practice by using flipped classroom methodology. Methods: After ethical committee approval and informed consent, 48 second year MBBS students were enrolled in the study. Selected topics (i.e., “nutrition in under-five children”) was taught through the “flipped classroom”model after a pretest assessment. Students were allotted a family case in the urban slums having at least one under-five child so that they can apply theory into practice. The formal assessment was done through structured case viva and spot examination. After 3 months, a posttest was conducted in the classroom to assess retention in knowledge. Feedback of the students was taken on the flipped classroom model. Results: The average marks scored in structured case viva with spot examination was 8.28 ± 2.4 marks. There was a statistically significant association of scores in the structured case viva with spot examination with participation in all pre- and in-class activities (P < 0.05). There was a statistically significant difference in pre- and posttest marks (10.03 ± 2.17 vs. 18.84 ± 3.8). The class average normalized gain was 44%. Overall, there was positive feedback for “flipped classroom teaching.” Most of the students felt that this was a practical approach to the topic. Discussion: Students can apply theory into practice and knowledge gained is also retained through the use of the flipped classroom teaching method.
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GENERAL ARTICLE Top

From one-district-one-doctor to the inclusive track: Lessons learned from a 12-year special recruitment program for medical education in Thailand p. 122
Win Techakehakij, Rajin Arora
DOI:10.4103/efh.EfH_139_18  PMID:32317417
Background: The One-District-One-Doctor (ODOD) medical education program was launched in 2005 with the purpose of increasing the production of rural doctors through special recruitment in Thailand. This article provides details of the ODOD program, together with its successes and challenges. Comparisons of the applied interventions between ODOD, the conventional rural recruitment program (Collaborative Project to Increase Production of Rural Doctors [CPIRD]), and the Inclusive track are also described. Methods: Compared with the CPIRD program, additional interventions are applied to the ODOD program, including (1) recruitment from remote rural areas; (2) subsidized education in return for service; and (3) extended compulsory service in rural areas with a higher penalty fine. While ODOD students have shown a relatively high rural retention rate, the program challenges include low admission rate, adverse consequences from an extended compulsory service, restriction on specialist training, and high penalty fee. Results: As a consequence of the program interventions, another special medical education program, the Inclusive track, was introduced as a replacement. Strategies through the Inclusive track to recruit students from remote rural areas are similar to those of ODOD. However, unlike ODOD, the Inclusive track has a reduced duration of compulsory service and penalty fine to match those of the standard requirements in the Normal track and CPIRD students. Discussion: Building on past experience, the Inclusive track pursues a balance of pros and cons from the other medical production programs. Program evaluation and close monitoring will be crucial to measure the feedback from the Inclusive track to further improve the sustainability of long-term retention of rural physicians.
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BRIEF COMMUNICATION Top

Medical students' critical thinking assessment with collaborative concept maps in a blended educational Strategy p. 127
Oscarina da Silva Ezequiel, Sandra Helena Cerrato Tibirica, Ivana Lucia Damasio Moutinho, Alessandra Lamas Granero Lucchetti, Giancarlo Lucchetti, Suely Grosseman, Paulo Marcondes-Carvalho-Jr
DOI:10.4103/efh.EfH_306_15  PMID:32317418
Background: Concept maps (CMs) are tools used to represent how new knowledge is integrated into the cognitive structure. In this study, we investigated the role of collaborative CMs in improving medical students' critical thinking and knowledge acquisition. Methods: A pre-post interventional study was conducted. In the 1st week of the clerkship rotation, a group of 10–14 students were asked by a faculty member to make a CM (CM1). After this first exposure (weeks 2/3), students learned the content through online forums. In the final week (week 4), students discussed what they had learned and made a final CM (CM2). Results: A total of 104 students participated in the study, making twenty CM1 and twenty CM2. There was a statistically significant difference between CM1 and CM2 for overall scores, proposition units, and hierarchy units (P < 0.001). Discussion: Collaborative CMs may be useful tools to help teachers better understand their students' critical thinking changes during a blended strategy.
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PERSONAL VIEW Top

The Network: TUFH and FAIMER-impact on initiating and maintaining a career path of a medical educationist p. 131
Adel Abdelaziz
DOI:10.4103/efh.EfH_351_17  PMID:32317419
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LETTERS TO THE EDITOR Top

Balancing health disparities through socially accountable medical education p. 133
Aleksandar Radonjic, Elika Yarkhani
DOI:10.4103/efh.EfH_160_19  PMID:32317420
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Time to reconsider our obsession with statistical significance p. 135
Sumeet Bhatt
DOI:10.4103/efh.EfH_155_19  PMID:32317421
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TUFH 40TH ANNIVERSARY SPECIAL PAPERS: PRACTICAL ADVICE PAPERS Top

Bridging the Atlantic: Optimizing the health of vulnerable community aggregates through international student exchange p. 136
Maryellen D Brisbois, Helder Rocha Pereira
DOI:10.4103/efh.EfH_268_19  PMID:32317422
Background: A growing diversity of cultures globally has intensified the need to educate health professionals to deliver safe, effective, and culturally appropriate care. Collaboration among global partners and development of cultural competence in nursing students in distant communities is one pedagogy to address competencies. Context: Universities in the United States (US) and Portugal established a bi-directional student exchange to foster professional relationships, enhance cultural awareness, identify health and health care roles from a global perspective, and explore collaborative research opportunities to address the health needs of vulnerable aggregates in both countries. Activities: Students from each country are paired to work collaboratively with faculty on research or health promotion projects, visit health care facilities, participate in university classes, language instruction, visit cultural and points of interest, and disseminate new knowledge. Outcomes: Students expressed an understanding of cultural differences and health care systems, reconsidered the role of community nurse, integrated theory into practice, and experienced peer mutual learning. A framework to organize philosophies related to a student exchange was developed. Future Directions: Forthcoming student exchanges are being planned. Work in previous exchanges allows for sustainability and a growing body of research and health promotion activities focused on impacting vulnerability in like communities in different countries. Conclusions: A shared vision of exchange, student involvement, multi inter-institutional research, perceived relevance of work with vulnerable groups, and improved ties between local and international community agencies allows for project sustainability. Student exchanges with vulnerable groups in communities provide a catalyst to promote heightened awareness of these aggregates.
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The collaborative care project: A practice-based approach to interprofessional education in a primary healthcare setting in South Africa p. 141
Jana Muller
DOI:10.4103/efh.EfH_276_19  PMID:32317423
Background: There is global evidence that primary healthcare (PHC) leads to improved health outcomes. In the South Africa PHC model, the PHC team identifies healthcare needs through community visits. For health professional students to learn this PHC model requires an immersed, interprofessional community experience. Context: A select number of final year undergraduate health science students from Stellenbosch University, South Africa spend six weeks to one full year working at a rural clinical school with the focus on contextualised, transformative and interprofessional clinical training. Objective: The collaborative care project is one of the opportunities aimed at exposing students to contextual interprofessional training in a resource constrained community. Students are challenged to collaboratively find potential solutions to problems patients face using local resources, with the aim of improving patient outcomes and transforming students into collaborative change agents. Activities: Students, under the supervision of local community health workers, are tasked with conducting interprofessional home visits for discharged patients or patients identified by community members. Possible environmental, personal and health risk factors are identified and referrals made to existing community or state facilities for further management. Outcome: The collaborative care project has resulted in improved patient identification, accessibility to available resources and referral. Students recognise the value of contextualised collaborative clinical training to shape them as clinicians. Challenges and successes are shared to encourage more practical, community based opportunities for collaborative care. Reciprocal teaching and learning take place and students express a change in self-perception, team identity and improved role clarification. Conclusion: This project creates an opportunity for students and community to improve their understanding of precipitating factors to illness, which are not often considered as routine health care and to find local solutions to problems identified.
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An innovative educational strategy to addressing cultural competence in healthcare for quilombola women p. 146
Reginaldo Antonio de Oliveira Freitas-Junior, Carolina Araujo Damasio Santos, Lilian Lira Lisboa, Ana Karla Monteiro Santana de Oliveira Freitas, George Dantas Azevedo
DOI:10.4103/efh.EfH_255_19  PMID:32317424
Background: The Quilombola community is made up of descendants of enslaved Africans. These people represent an ethnic minority group within the Brazilian Black population with worse health indicators including higher rates of maternal mortality. Context: The Brazilian National Guidelines for education of health professionals state that cultural competence and education of ethnic-racial relations need to be reinforced. Activities: An action research initiative was developed with the main goal of contributing to the development of cultural competence, interprofessional education, and collaborative work as well as improving the maternal and child indicators of the Quilombola community. An elective module for undergraduate health courses with the subject “Cultural Competence in Health Care for Quilombola Women” was implemented. Data on health-related needs identification, students' perceptions about interactions with the community, and competencies necessary to work with the Quilombola community were considered. Outcomes: Our educational strategy reinforces the importance of considering the processes that influence the health care of this population. The reflective capacity and communication skills emerged as the most important attitudinal and psychomotor components, respectively. Future Directions: Sustainability comes from partnerships established between the Quilombola community and the university to institutionalize educational and research strategies. This project contributes to reducing health inequities and deconstructing racism in the training of future health professionals. Conclusions: The creation of links, the building of trust between users and health staff, and the ability to reflect, with emphasis on communication, were shown as the main components of culturally competent behavior in maternal health care in the studied Quilombola population.
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A arte de nascer (The art of being born) p. 150
Carolina Araujo Damasio Santos, Lilian Lira Lisboa, Alexandra Nascimento Cassiano, Alexandra Silva de Lima, Reginaldo Antonio de Oliveira Freitas-Junior
DOI:10.4103/efh.EfH_260_19  PMID:32317425
In 2008, this project began with a small group of volunteers in a poor rural community in northeastern Brazil using art therapy to increase the knowledge of pregnant women about gestation, birth, and care of their babies. After positive results were seen within that community, the methodology was published as a book to be replicated in other states of Brazil. In 2010/2011, after being selected as a “Young Champions of Maternal Health” winner by Ashoka and Maternal Task Force competition, the project was adapted for the local culture in Mali and replicated in villages in West Africa with workshops using songs, poems, stories, crafts, and cinema. It continues to be implemented throughout Brazil, and since 2012, at the Institute Santos Dumont, a health, teaching, and research center in a rural area in Northeast Brazil. It is also used as a teaching strategy for students of medicine, physiotherapy, psychology, resident doctors, and multiprofessionals. It contributes to the development of attitudes, health education skills, and interprofessional education experience. It also provides information and educates groups to empower women about their health and rights to make informed choices regarding pregnancy and childbirth.
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