|TUFH 40TH ANNIVERSARY SPECIAL PAPERS: PRACTICAL ADVICE PAPER
|Year : 2020 | Volume
| Issue : 2 | Page : 51-54
Community intervention projects as a strategy to integrate essential public health functions (EPHF) with clinical knowledge into the curriculum of medicine
Department of Public Health, San Martin University Foundation - Sabaneta Campus, Sabaneta, Antioquia, Colombia
|Date of Submission||16-Jun-2020|
|Date of Acceptance||02-Jul-2020|
|Date of Web Publication||08-Dec-2020|
Carrera 78 45 A 127, Medellin, Antioquia
Source of Support: None, Conflict of Interest: None
Background: Students in medical school often do not get the opportunity to apply public health principles to their work. This can affect the likelihood that they will apply population and public health principles in practice. Activities: From 2010 to 2015, the faculty of Medicine at Fundacion Universitaria San Martin from Sabaneta Campus – Colombia, developed an educational strategy called “Community Health Intervention Projects” (CHIP) as a new way to integrate essential public health functions with clinical knowledge into the curriculum. This approach was based on Community-Based Medical Education (COME) and Community-Oriented Primary Care. Seven CHIPS were developed by 65 undergraduate students partnering with organizations as two secondary schools, one clinic, two community-based groups, one nongovernmental organization, and two secretaries of health in four different cities. Outcomes: The breastfeeding programs increased the time of breastfeeding by the mothers and the tools to measure breastfeeding have been used in other research projects (Medellin 2015, Envigado 2017). The project about increasing Knowledge, Attitudes, and Practices in Sexual and Reproductive Health (SRH) in young scholars from two cities (Caldas and Sabaneta) served as a springboard for one of the students of medicine to receive a scholarship to attend the global forum in SRH “Women Deliver” in Kuala Lumpur in 2013. The project about Comprehensive and Integrated Delivery Health-care Program, addressed to children with asthma, were adopted by the Ambulatory Clinics Organization after the results of the pilot program (2016–2017). This project won the TUFH– FAIMER student projects for health award in 2016, showing the sustainability and generalizability of the educational program. Conclusion: Health professions educators can use CHIPS to integrate the mission-related axes in their programs: Academia, research, and extension activities in a community setting.
Keywords: Community-based education, community-oriented primary care, public health essential functions
|How to cite this article:|
Sosa M. Community intervention projects as a strategy to integrate essential public health functions (EPHF) with clinical knowledge into the curriculum of medicine. Educ Health 2020;33:51-4
|How to cite this URL:|
Sosa M. Community intervention projects as a strategy to integrate essential public health functions (EPHF) with clinical knowledge into the curriculum of medicine. Educ Health [serial online] 2020 [cited 2021 Apr 21];33:51-4. Available from: https://www.educationforhealth.net/text.asp?2020/33/2/51/302485
| Background|| |
Medical students and practicing physicians do not integrate Essential Public Health Functions (EPFH) (Pan American Health Organization 2002) in their current activities and do not see how this knowledge can be applied during consultations. In other words, there is a disconnect between public or population health and individual or patient health.
An educational strategy called “Community Health Intervention Project” (CHIP) was developed to correct this situation. CHIP integrates EPFH and clinical activities for outpatients in the community settings. Through this strategy, the students must apply both clinical and EPFH knowledge to a concrete health problem affecting a community group.
| Context|| |
Since 2010, the Faculty of Medicine of Fundacion Universitaria San Martin at Sabaneta Campus has been integrating Community Based Medical Educacion as a strategy to increase competencies of medical students in different fields such as leadership, team work, health planning, and primary health care.
On 3rd year, medical students must start a research project on any health topic and complete it before entry to internship in the 6th year of study. Nevertheless, students rarely choose public health problems. For this reason, CHIP was designed as a strategy for those students who prefer to conduct the practical research by developing the understanding of a community health problem and then doing something to correct it by integrating two approaches: Clinical and public health. The strategy was approved by Faculty Council in 2010. By 2015, seven CHIPS were developed addressing the different kinds of community health problems in the same number of communities by more than 65 students of medicine. The principles of these projects were as follows:
- Understand the complexity of health delivery services under the concept of Renewed Primary Health-Care Approach proposed by the Pan American Health Organization/World Health Organization (2008)
- Increase the skills and competences of the students in an integrated and comprehensive model of care that includes health promotion, prevention, early diagnosis, treatment, rehabilitation, health management, measuring, and indicators
- Develop the skills of leadership, teamwork, communication for health, and patient-centered care.
- Increase the level of health of communities for a specific health problem or need
- Change behavior and attitudes around health/disease problems.
- Integrate the social determinants of health proposed by Dahlgren and Whitehead at the singular (person) or family (community group) level
- Develop Community-Based Medical Education (COME) (Menin, 2006) and Community Oriented Primary Care [6,7] at the same time as a methodological and pedagogical approach.
| Activities|| |
Each group of 5–8 students of the 3rd year of medicine choose a community, community group, or outpatient group with a health problem to be addressed during the next 2 years.
The groups of students go to the community to find and define a community health need to be fulfilled by the project. The first activity is making a participatory community health diagnosis to choose community groups or outpatient group with different health needs. The problem must be chosen with agreement of the community leaders, health directors, or other stakeholders interested in resolving the encountered problem. Once groups and problems have been selected, the students with the community or group leaders and other stakeholders design and develop a CHIP, defining all plans, strategies, and indicators to measure outcomes and impacts. The public health department supports them with methodologies and assessment tools as part of the curriculum.
Once students have identified a chosen community problem, they are trained in designing a CHIP using a logic model, ZOPP, or other program evaluation methodologies. [8,9] These methodologies have been adapted to facilitate the application by the students. The steps start with completing problem and solutions trees. Next, students make an involved actor matrix and analyze it to find two key points: At which moment of the project can each of them participate and what is his/her interest in the project. The last step is defining objectives, activities, tasks, resources, and indicators or goals and outcomes.
The groups of students go back to the community and organizations to negotiate the CHIP, especially if the projects require funds or community resources. In this step, the group of students is trained in leadership, negotiation, and management to define different tactics and strategies according to the stakeholders involved.
Once the project is negotiated, the students must design contents and workshops, didactic materials, tools to evaluate it and any kind of resources to be used. In this step, the student must apply their knowledge in health promotion, education for health, health prevention, protocols and guides in clinics, and health services management that they have learned thus far in their career in medicine.
During these 2 years, clinicians and public health teachers advise each group of students on health problems or circumstances that they found in the community or group. This advice is one way to assure a good application of both clinical and public health competencies and to prevent mistakes by students. The steps to develop a CHIP are presented in more detail in the next section.
Before starting the intervention, the groups of students do a baseline study of the areas designated for intervention and investigation before developing the activities. This baseline is very important to measure the impact of the project. This is a key moment to assure how to integrate EPFH, Research and Clinics to create an integrated and comprehensive CHIP.
The group of students decides who of them will be responsible for each activity and their tasks, who is the “manager” of the group, who is the monitoring leader and which topic around the health problem will be addressed by each student. The group of students creates a baseline for the topics to be investigated before developing the activities. This baseline is very important to measure the impact of the project. In this way, the students can learn about teamwork and leadership.
During of the entire intervention, the students apply monitoring and evaluation tools to evaluate the project goals and outcomes and to correct or adapt the activities according to the resources and results.
Finally, the students present results to the community leaders, the organizations involved and the faculty of medicine. The students make a presentation about all processes and results. Their results are written as an article to be published.
| Outcomes|| |
Between 2010 and 2015, seven CHIPs were developed by 65 undergraduate students. Eight partnerships were developed with different kinds of organizations from four different cities, including two secondary schools, one clinic, two community groups, one nongovernmental organization, and two Secretaries of Health. The examples of project results are provided below.
One project was designed to increase breastfeeding in mothers with children under 1 year old in two cities (Envigado and Sabaneta). The breastfeeding time was increased for all mothers from to 12 to 18 weeks, and the tools to measure the indicators of breastfeeding have been used in other research projects in Medellin (2015) and Envigado (2017). Another project increased knowledge in health rights and debts in two communities: One rural community of Sabaneta City and one Comuna of Medellin.
A third project was created to increase Knowledge, Attitudes, and Practices in Sexual and Reproductive Health (SRH) in young scholars from two cities (Caldas and Sabaneta). The statistics in sexual behavior, pregnancy, and sexually transmitted disease in scholars improved in the two schools that were included in the project. The tools used to measure the baseline were applied in two other cities. This project served as a springboard for one student of medicine to receive a scholarship to present at the global forum in SRH “Women Deliver” in Kuala Lumpur 2013.
A fourth project was the comprehensive and integrated delivery health-care program to attend children with asthma in ambulatory clinics of Saludcoop (Assurance health Company) in Medellin. This project was recognized with an award from TUFH– FAIMER in the “Student Projects that Work” competition of 2016. The tools and adaptations of clinical records for the asthma project were adopted by the Ambulatory Clinics Organization after the results of the pilot program (2016–2017).
The last outcome is an indirect indicator of the benefit of CHIP for the participating students. Between 2013 and 2015, they earned the highest level of competence in health promotion and health management fields as evaluated by the undergraduate health national test.
| Conclusion|| |
This approach to integrating various types of knowledge in the health field (clinical, research, and essential public health functions EPHF) , whereas developing competencies needed by physicians in the new century (leadership, teamwork, and education for health), also achieves the goals of improving health services, patient satisfaction, and population health. All this can be achieved inside a single CHIP that is developed in parallel with the curriculum of medicine. It can be seen as a new and different approach to increasing competencies for undergraduate students of medicine and at the same time increasing the links between faculties of medicine with communities, leaders, and health organizations to achieve better results for the health of populations. CHIP can be done as a strategy to integrate any kind of health knowledge for many schools and faculties of health (nursing, medicine, nutrition, psychology, social work, and odontology) around the world.
As a strategy, CHIP continues in the curriculum of the faculty of medicine and many students want to create their own CHIP. We are looking for new communities and community-based organizations that can be work with us. One problem is the lack of public health teachers to support a lot of projects. This circumstance limits the capacity of the department to increase the number of projects.
This project worked because:
- It was conceived around integrated competencies of physicians and less around specific or isolated fields of knowledge. Furthermore, it enables students to learn inside a real problem
- The communities, organizations, leaders, and other possible partners see the CHIP and the students as a real and valuable resource to solve current health problems
- The faculty or school of medicine can use the project to integrate three mission-related axes: Academia, research, and extension (community-based) activities.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Pan American Health Organization. Public health in the americas. conceptual renewal, performance assessment, and bases for action. Chapter 3. Essential Public Health Functions (EPHF). Washington, D.C.: Scientific and technical publication No. 589. 2002. ISBN: 92 75115893.
Cohen J, Crisp N, Evans T et al
. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376:1923-58. doi:10.1016/S0140-6736(10)61854-5
Mennin S, Petroni-Mennin R. Community-based medical education Blackwell Publishing Ltd 2006. Clin Teacher 2006;3:90-6.
Blumenthal DS. Clinical Community Health: Revisiting “The Community as Patient” Education for Health; 2009. Volume: 22 | Issue Number: 2 | Page: 234-234
Gjos T, Hagen S, Ronning A, Samset K, Sletten E, Stoll I, Strand A. Enfoque del Marco Lógico como herramienta para planificación y gestión de proyectos orientados por objetivos. Agencia Noruega de Cooperación para el desarrollo NORAD. Madrid España Versión en español; 1993.
Nkwake A. Working with Assumptions in International Development Program Evaluation. Chapter 5 Theory in Evaluation. DOI: 10.1007/978-1-4614-4797-2_2.Springer Science + Business Media. New York.; 2013.