Student learning outcomes,perceptions and beliefs in the context of strengthening research integration into the first year of medical school

Research integrated into undergraduate education is important in order for medical students to understand and value research for later clinical practice. Therefore, attempts are being made to strengthen the integration of research into teaching from the first year onwards. First-year students may interpret attempts made to strengthen research integration differently than intended by teachers. This might be explained by student beliefs about learning and research as well as student perceptions of the learning environment. In general, student perceptions of the learning environment play a pivotal role in fostering student learning outcomes. This study aims to determine whether a curriculum change intended to promote research integration fosters student learning outcomes and student perceptions of research integrated into teaching. To serve this purpose, three subsequent cohorts of first-year students were compared, one before and two after a curriculum change. Learning outcomes of these students were measured using scores on a national progress test of 921 students and assessments of a sample of 100 research reports of a first-year student research project. 746 Students filled out the Student Perceptions of Research Integration Questionnaire. The findings suggest that learning outcomes of these students, that is, scores on research related test items of the progress test and the quality of research reports, were better than those of students before the curriculum change.     

Social learning in a longitudinal integrated clinical placement

Recent research has demonstrated that longitudinal integrated placements (LICs) are an alternative mode of clinical education to traditional placements. Extended student engagement in community settings provide the advantages of educational continuity as well as increased service provision in underserved areas. Developing and maintaining LICs require a differing approach to student learning than that for traditional placements. There has been little theoretically informed empirical research that has offered explanations of which are the important factors that promote student learning in LICs and the relationships between those factors. We explored the relationship between student learning, student perceptions of preparedness for practice and student engagement, in the context of a rural LIC. We used a sequential qualitative design employing thematic, comparative and relational analysis of data from student interviews (n = 18) to understand possible processes and mechanisms of student learning in the LIC. Through the theoretical lens of social learning systems, we identified two major themes; connectivity and preparedness for practice. Connectivity described engagement and relationship building by students, across formal and informal learning experiences, interprofessional interactions, social interactions with colleagues, interaction with patients outside of the clinical setting, and the extent of integration in the wider community. Preparedness for practice, reflected students’ perceptions of having sufficient depth in clinical skills, personal and professional development, cultural awareness and understanding of the health system, to work in that system. A comparative analysis compared the nature and variation of learning across students. In a relational analysis, there was a positive association between connectivity and preparedness for practice. Connectivity is a powerful enabler of students’ agentic engagement, collaboration, and learning within an LIC. It is related to student perceptions of preparedness for practice. These findings provide insight for institutions wishing to develop similar programmes, by encouraging health professional educators to consider all of the potential elements of the placements, which most promote connectivity.     

Relationship between adolescent health behaviors and self-esteem in Turkey

The main objectives of this article were to present first adolescent self-esteem levels including its predictors and second to show the correlations between student self-esteem evaluations, health compromising and risk behaviors. This study was a part of a larger comparative youth research with questionnaires to the students in grade eleven in the Yenimahalle district of Ankara, Turkey. A brief group type questionnaire was administered to the 310 students. The results showed that, the students were not homogeneous in terms of their positive and negative self-esteem levels. Regression analysis revealed that father's educational level as an independent variable was effective on positive self-esteem scores. Gender was effective on student negative self-esteem ratings. It was also found that there was a significant correlation between student self-esteem evaluations and perceptions about other students along with health compromising and risk behaviors. Prevention implications and recommendations are discussed.     

Workplace health promotion: Benefit or burden to low-paid workers

This paper explores the implications of workplace health promotion, particularly in relation to the needs of people in low-paid employment. The paper draws on research carried out during 1995 involving a telephone survey of 101 employing organizations in the Avon area of England. The influence of organizational factors such as size and business sector on health activity in the workplace were examined, together with perceptions about the take up of workplace health promotion by people in low-paid employment. The survey also explored the extent of professional and worker involvement in planning workplace health activity. Case study research explored the links between occupational health provision and health promotion activity in three different workplaces. Implications of the research for policy and practice are discussed.     

Second year medical student opinion about public health and a second year course in preventive medicine and community health

The results of five annual surveys of second year medical students over an eight year period of time (1978–1985) concerning perceptions and attitudes toward public health and a course in preventive medicine and community health are presented. The questionnaire format was a combined fixed alternate and free response type and was structured to require only ten to 15 minutes for its completion. Participation rates were generally high varying from 60.2% (1980) to 93.8% (1985). The majority of students in all years favorably evaluated most components of structure, content and presentation of the course. It was found that opinions about the course can be modified by the introduction of variables that are unrelated to the scope of the quality of the course as occurred in 1979, with a difficult midterm examination. Student anger over this examination was translated and expressed as negative opinion about many other aspects of the course which in other years were highly rated. This finding underscores the vulnerability of surveys of subjective opinion and demonstrates that course evaluations must include other objective aspects in addition to student perceptions.Pascal James Imperato, M.D., M.P.H. & T.M., is Professor and Chairman of the Department of Preventive Medicine and Community Health, State University of New York Health Science Center at Brooklyn.Joseph Feldman, Dr. P.H. is Professor, Department of Preventive Medicine and Community Health, State University of New York Health Science Center at Brooklyn.Kamran Nayeri, B.A. is Instructor, Department of Preventive Medicine and Community Health, State University of New York Health Science Center at Brooklyn.     

An analysis of service quality at a student health center.

This study provides an analysis of the quality of service provided by a university health care center. Students' expectations and perceptions of the center's services are identified by a survey. A second survey was administered to the employees of the center to compare student perceptions to those of the employees. Based on the results of this study, specific recommendations are made to improve the performance of the center. The implementation of these recommendations should also reflect a change in the students' perceptions about the quality of service provided by the center.     

Identifying barriers to the use of research faced by public health physicians in Norway and developing an intervention to reduce them

OBJECTIVES: To explore why public health physicians seldom use research-based information and to develop an intervention to remedy this on the basis of this study, other research literature and suitable theories of information-seeking and professional behaviour change. METHODS: A qualitative study was conducted using focus groups, observation of individuals and interviews. The setting was Norwegian public health practice; 52 public health physicians from all over Norway participated in the study. RESULTS: We identified several barriers to the use of scientific literature that could be categorised as: psychological variables; environmental variables; and source characteristics. We developed an intervention that attempts to address these barriers, informed by previous research on the effectiveness of interventions to change professional practice and incorporating elements from social cognitive theories and the theory of innovation diffusion. CONCLUSIONS: The Norweigian public health physician works in an isolated environment which does not facilitate searching or obtaining scientific information, which does not ask for this information and far less encourages its use as a basis for decision-making. An intervention tailored to reduce some of the barriers to research use may lead to more frequent and extensive use of such information in public health decision-making.     

Multiple health risk behaviors in German first year university students

Multiple health risk behaviors have been identified as a problem in young adults which includes university students. The goals of this study included assessing the prevalence of major health risk behaviors in a cohort of German first year university students, analyzing the clustering of these behaviors and assessing readiness to change across multiple behaviors. A total of 1262 students from the schools of law, teaching and medicine at a German university participated in a voluntary and anonymous survey in 2005. The study assessed indicators and readiness for change regarding fruit and vegetable consumption, exercise, smoking and binge drinking as well as sociodemographic variables. Confirming the hypotheses, prevalences for risk behaviors were high; over 95% ate less than five servings of fruits and vegetables, 60% did not exercise sufficiently, 31% were current smokers and 62% reported binge drinking. Only 2% had none, 10.5% had one, 34.5% had two, 34.8% had three, and 18.2% showed all four risk behaviors. Readiness for behavior change was very low across multiple risk behavior combinations, especially for reducing binge drinking and increasing fruit and vegetable consumption. Medical students showed slightly more positive patterns than other students. The results indicate the need for addressing health behaviors in the student population of this university. If these findings can be replicated in other universities, programs that promote individual behavior change as well as changes in environmental conditions in the university environment are necessary to address this urgent problem.     

A glimpse into the future: a survey of the expectations and ambitions of Australian health information management students

The future of the health information management profession is largely dependent on the ability of educational programs to attract high-caliber students who have a clear understanding of their future career when entering their course and who aspire to become active members of the profession after graduation. A sample of Australian health information management students was surveyed to obtain information about satisfaction with their career choice, employment options, and intended involvement in professional and postgraduate education activities. The survey looked for differences between the responses of students at different stages of their courses and changes in student responses over time. The majority of students believed that they had made the correct career choice. There was a general preference for nontraditional health information management employment positions on graduation and a strong commitment to professional involvement and postgraduate education. Significant differences in some questionnaire responses were found among the student groups. Students' responses to questionnaire items about their future careers were less likely to change compared with other questionnaire items. Implications of the results for the health information management profession and educational institutions are discussed.     

A research-based narrative assignment for global health education

There is a paucity of research on novel approaches to classroom-based global health education despite the growing popularity of this topic in health professional curricula. The purpose of the following paper is to (1) describe the rationale underlying the use of a research-based narrative assignment for global health education, and (2) describe the results from an evaluation of this assignment with undergraduate public health students, including its strengths and limitations. The research-based narrative assignment was implemented during an introductory global health course for third and fourth year undergraduate public health students. The students (n = 20) completed the assignment and then wrote a two-page reflection about their experience. The author analyzed these student reflections using open coding and thematic analysis. Four salient themes were identified from the written reflections including (1) the challenge of representing persons, (2) the opportunity to develop an engaged understanding of the chosen issue, (3) seeing the bigger picture or integrating the various determinants into a coherence story, and finally (4) the struggle to create a compelling story that was based on accurate information. The analysis of the students’ reflections provides important insights into their experience conducting this assignment, particularly in highlighting key strengths and challenges of this approach. These strengths and challenges are discussed.     

Making medical education relevant to health care systems

Medical education must be made relevant, and this implies that it must train its students towards the local health care system. If behavioural objectives are defined which must be attained before a student graduates, and before he can function effectively in a health unit, areas which need emphasis are revealed. Communication is a skill which can be left to clinical training: but it is best learned very early in the community, where the student is the supplicant, and not in the hospital where he is dominant. Early community experience can mould a student's attitudes fundamentally and can make him realise the need for work with members of a health team within a health care unit. If education is dogma-centred, and the student is not trained to ask questions early he will not be able to function effectively in any community: modern medical education should be problem-dominated, community-directed and learner-centred. If it is centred on the learner he will become equipped with the ability for independent study and a desire to learn, to improve himself and help other members of the health team throughout his professional career.     

The forgotten dimensions in health education research

This paper evaluates the content focus of health education research as presented in the professional literature over a 6-year period (2000-2005). The majority of research (1365 papers) addresses the physical dimension of health (79%), while other health dimensions receive less attention. It is argued that the current content focus of research in health education fails to harmonize with the multidimensional, dynamic and functional nature of health as generally defined. The goal of health education, positive behavior change, also seems less reachable without a better understanding of how nonphysical dimensions of health influence wellness behaviors. At present, there exists an opportunity for health educators to move toward research agendas that more fully appreciate the interconnectedness of various dimensions of health and that evaluate them evenhandedly. Practical application of this approach will require a partial break from the biological orientations of other health professions, new research agendas that clarify multidimensional health relationships and new programs that seek to influence outcomes in a variety of dimensions.     

Seasonality,disease and behavior: Using multiple methods to explore socio-environmental health risks in the Mekong Delta

Any analysis of how changing environmental hazards impact on public health is fundamentally constrained unless it recognizes the centrality of the social and behavioral dimensions of risk. This paper reports on a research project conducted among low-income peri-urban households in the Mekong Delta of Vietnam. The research was based on cross-disciplinary inputs to develop a multi-layered understanding of the implications of a dynamic seasonal environment for diarrheal disease risk. It is a widely held assumption that the major changes in the abundance of surface water between the flood and dry seasons in the Mekong Delta are likely to be reflected in the changing patterns of disease risk, especially for poorer households that tend to rely heavily on river water for domestic water use. Therefore, this study investigated seasonal patterns in the contamination of environmental water, incidences of diarrheal illnesses, water use and hygiene behavior, together with perceptions of health risks and seasonality. During the period of October 2007 to October 2008, the UK and Vietnamese research team worked with a total of 120 households in four low-income sites around the city of Long Xuyen to conduct water testing; administer questionnaires on self-reported health, risk perceptions and behavior; and conduct semi-structured interviews. The research team found no overall evidence of a systematic seasonal risk pattern. At the population level, marginal temporal variations in water quality in the environment failed to translate into health outcomes. A complex risk narrative emerged from the interweaving data elements, demonstrating major inter- and intra-household variations in risk perceptions, hygiene behavior, seasonal behavior and other risk factors. It is suggested that these complexities of human behavior and transmission routes challenge simplistic assumptions about change in health outcomes as a result of seasonal environmental changes. These findings demonstrate the key role social science can play in a holistic and critical analysis of environment and health interactions.     

Attitudes of health sciences students towards interprofessional teamwork and education

Relatively little is known about the specific attributes of health professional students which may influence their attitudes towards both interprofessional teamwork and interprofessional education. A survey was distributed to all pre-licensure health professional students from medicine, nursing, pharmacy and social work programmes at our institution. Respondents were asked to rate their attitudes towards interprofessional healthcare teams and interprofessional education using validated and reliable scales reported in the literature. Information on the respondents' gender, profession, year of study and prior experience with interprofessional education was also collected. There was no significant difference between attitudes of medicine and nursing students towards interprofessional teamwork; however, both these student groups report significantly less positive attitudes towards interprofessional teams than pharmacy and social work students. Medicine students reported significantly less positive attitudes towards interprofessional education than nursing, pharmacy and social work students. Female students and senior undergraduate students reported significantly more positive attitudes towards interprofessional teamwork and interprofessional education, while students reporting prior experience with interprofessional education reported significantly more positive attitudes towards interprofessional teamwork. Profession, gender and year of study appear to be attributes which were related to more positive attitudes towards both interprofessional teamwork and education.     

Benefit or burden: introducing paraprofessional support staff to health visiting teams: the case of Starting Well

With increased public-sector funding to expand and improve frontline services, pre-existing skill shortages within key professional workforces have become more acute. One response to this has been to encourage the development of skill-mix approaches which allow tasks previously undertaken by professional staff groupings to be assumed by new paraprofessional employees. Within the UK National Health Service, one group of professionals who are being challenged to change their way of working in this way are health visitors. Starting Well, one of Scotland's four health demonstration projects, which was established in 2000 to bring about a step-change in child health within deprived communities in Glasgow, operated as a pilot for such a skill-mix model of health visiting. The project was evaluated using a multimethod approach that encompassed the study of both processes and outcomes. The present paper reports on a process evaluation of the project's implementation that addressed the rationale underlying the development of Starting Well's skill-mix approach and the challenges which this model faced in practice. The perceptions of both managerial staff (n=18) and those working in practice (n=33) were gathered using semistructured interviews which sought to elicit and test Starting Well's theory of change in relation to the use of paraprofessional staff. Two sets of interviews were conducted with each group of staff between 2001 and 2003. Two main types of challenge were identified: deploying potentially vulnerable members of staff; and co-management of paraprofessionals by the health service and a voluntary-sector organisation. A potential challenge identified from the literature, i.e. that of implementing a new role within an existing team, proved to be less problematic within Starting Well. These issues are discussed in relation to current policy and practice debates.     

Communication between health care professionals and deaf patients

A review of the literature about communication between health care professionals and deaf people demonstrates that a continuum of accuracy in perceptions of deaf people and their communication problems exists in health care settings. The author provides information on deaf culture, history, population size, sign language, and communication needs that is used to evaluate professional journal articles. Examples of research on this topic are presented and the need for further studies and the role of social workers are discussed.     

Mental health services in Perth nursing homes

Directors of nursing (DONs) in 42 nursing homes in Perth were asked for information concerning mental health services provided for their residents. A questionnaire similar to those used by other researchers in Sydney and in Ontario was utilised to enable meaningful comparisons among the three studies. According to the DONs' perceptions, the mean proportion of residents in Perth nursing homes with psychiatric and/or behavioural problems was between 50% and 75%. The mental health services provided to nursing homes were significantly less than that desired by the DONs. Other variables assessed in this study included the number of transfers per year because of psychiatric problems; the number of staff with psychiatric qualifications; the provision of psychiatric training for staff; the most frequently occurring psychiatric problems in residents and the most valued mental health services provided to nursing homes. Results were comparable to those of the Sydney and Ontario studies. This study suggests that there is a significant psychiatric population in Perth nursing homes that, like those in Sydney and Ontario are seriously neglected regarding appropriate professional psychiatric care. Existing psychogeriatric community assessment teams could provide more of these services if adequately staffed and resourced.     

A interdisciplinary community partnership for health professional students: a service-learning approach

This paper presents a qualitative approach to studying the reflective learning experiences of health professional students after they participate in an interdisciplinary community-based healthcare course. Over a 2-year period, health professional students from various health-related disciplines voluntarily took an interdisciplinary community-based health course offered at an urban, mid-Atlantic, private university. Through didactic and experiential opportunities, students in the course learned the importance of providing health care services to underserved populations at urban community-based sites. Throughout the semester, students kept journals, completed community response forms, and participated in documented class discussions. A research team of health professional faculty applied constant comparative analyses to the journal entries and community site-visit response forms. Four central themes were identified as the students engaged in learning experiences at various community sites: (1) the need for preventive healthcare; (2) the importance of health services and resources; (3) the awareness of student attitude and behavioral changes; and (4) increased awareness of student and client expectations for health care services. Interpretations of these findings and recommendations for future research are presented.