Recruiting and Retaining Mental Health Professionals to Rural Communities: An Interdisciplinary Course In Appalachia

CONTEXT: Faculty from 5 disciplines (health administration, nursing, psychology, social work, and special education) collaborated to develop and teach a distance-learning course designed to encourage undergraduate and graduate students to seek mental health services employment in rural areas and to provide the skills, experience, and knowledge necessary for successful rural practice. METHODS: The primary objectives of the course, developed after thorough review of the rural retention and recruitment literature, were to (1) enhance interdisciplinary team skills, (2) employ technology as a tool for mental health practitioners, and (3) enhance student understanding of Appalachian culture and rural mental health. Didactic instruction emphasized Appalachian culture, rural mental health, teamwork and communication, professional ethics, and technology. Students were introduced to videoconferencing, asynchronous and synchronous communication, and Internet search tools. Working in teams of 3 or 4, students grappled with professional and cultural issues plus team process as they worked through a hypothetical case of a sexually abused youngster. The course required participants to engage in a nontraditional manner by immersing students in Web-based teams. FINDINGS: Student evaluations suggested that teaching facts or "content" about rural mental health and Appalachian culture was much easier than the "process" of using new technologies or working in teams. CONCLUSIONS: Given that the delivery of mental health care demands collaboration and teamwork and that rural practice relies increasingly more on the use of technology, our experience suggests that more team-based, technology-driven courses are needed to better prepare students for clinical practice.     

St Joseph's Community Health Centre model of community-based interdisciplinary health care team education

As our reliance on interdisciplinary health care teams for meeting the multidimensional needs of the community becomes greater, new interdisciplinary education programmes and learning experiences are needed to educate students and health care professionals to become better team players. The St Joseph's Community Health Centre (SJCHC) model of community-based interdisciplinary health care team education was developed with support from McMaster University and the Educational Centre for Aging and Health's Clinical Teaching Unit Without Walls. The SJCHC model is structured as one 3-h session each week for eight consecutive weeks and is an elective learning experience for students. Six to eight senior health, social science and other health-related students work with two group facilitators as a team on discussion theme topics: team dynamics; role issues and professional values; collaboration and conflict; communication, leadership and power; client-centred goal-oriented care; and consumerism issues. The success and impact of the SJCHC model has been measured by several primary and secondary outcomes outlined in the Charting the Outcomes of Educational and Clinical Approaches (COECA) model.     

Interdisciplinary didactic instruction at academic health centers in the United States: attitudes and barriers

Interdisciplinary care is a method of providing patient care through a team approach that incorporates the efforts of various health care providers. Studies show that this approach can improve patient care and decrease overall costs to the healthcare system. Despite the evidence for the benefits of interdisciplinary care, there are no well-defined models for training students during their didactic years to become members of an interdisciplinary team. This study utilized an investigator-developed questionnaire to determine the attitudes of administrators of professional schools in the USA toward interdisciplinary education, identified the perceived barriers to interdisciplinary education, examined the extent to which interdisciplinary education is occurring at academic health center campuses, and identified the courses that might best be taught in an interdisciplinary format. Administrators from medicine, nursing, and pharmacy hold positive attitudes toward interdisciplinary instruction. Respondents from nursing and pharmacy hold more favorable attitudes than their counterparts from medicine. Positive attitudes are seen more frequently among females than males, and among respondents from public single and multi-campuses than from private campuses. This study demonstrated that administrators espouse very positive attitudes toward interdisciplinary education, although they perceive the barriers to interdisciplinary education and the courses most suited for anointer disciplinary approach differently. More discussions among administrators of various disciplines may allow barriers to be overcome and allow development of interdisciplinary didactic courses that could test the hypothesis that these courses are more cost effective and more likely to foster interdisciplinary teamwork in the clinical setting. This revised version was published online in June 2006 with corrections to the Cover Date.     

Interdisciplinary education as a facet of health care policy: the impact of attitudinal research

The past decade has seen a move toward a conscious interdisciplinary practice in health care delivery. Spurred on by intractable issues of fragmentation of services and lack of comprehensiveness, the proliferation of team and other kinds of integrated models have been reported in the literature but seldom conceptualized for their potential impact on service. Moreover, the literature generally lacks an empirical base and can be characterized as ideological. Educational institutions have remained largely untouched structurally in regard to providing interdisciplinary models of education, and issues such as the professional "hierarchies" in health and "turf" are seen as barriers to institutional response. This article describes a program of interdisciplinary education at one university, specifically in the context of potential impact on educational policies. The interdisciplinary health education program began as an informal, voluntary arrangement among four health-related professional schools and ultimately involved six schools. Research on cognitive and attitudinal learning of participating students was undertaken, supporting the educational rationale for conjoint, problem-focused learning. The article traces the history of the program's impact on education policies and points to the need for a stronger empirical base. Innovative education experiences, constructed from the earlier research undertaken, are described.     

On the value of architecture and facility management in health administration education

This article discusses the role and function of architecture and facility management in health administration education vis-à-vis an interdisciplinary set of courses taught in a graduate-level health administration program. These courses provide the future health care executive with theory and applied knowledge on a variety of topics. These include the history of health care facilities, issues in facility planning and management, principles of patient and staff-focused design, campus master planning, participatory methods to involve end users in the design of their work, and care settings. Additional skills acquired include an introduction to contract negotiations, the reading of technical documents such as blueprints, the post-occupancy assessment of facilities-in-use, and familiarity with future trends. Students address the topic of managerial ethics in relation to the built environment in some detail as a vehicle to illustrate the nature of key fine-grain issues of importance to the health administration scholar and professional. The discussion concludes with the presentation of a model curriculum in this subject area.     

Communication,Aging, and Health: Toward Understanding Health Provider Relationships with Older Clients

This special issue on communication, aging, and health draws attention to the ways in which communication issues are central to the health and health care of older adults. This introduction provides a theoretical framework for the other articles in this issue based on the Communication Predicament of Aging model, and it highlights priorities for future collaborative interdisciplinary studies.     

Interdisciplinary education and teamwork: a long and winding road

PURPOSE: This article examines literature on interdisciplinary education and teamwork in health care, to discover the major issues and best practices. METHODS: A literature review of mainly North American articles using search terms such as interdisciplinary, interprofessional, multidisciplinary with medical education. MAIN FINDINGS: Two issues are emerging in health care as clinicians face the complexities of current patient care: the need for specialized health professionals, and the need for these professionals to collaborate. Interdisciplinary health care teams with members from many professions answer the call by working together, collaborating and communicating closely to optimize patient care. Education on how to function within a team is essential if the endeavour is to succeed. Two main categories of issues emerged: those related to the medical education system and those related to the content of the education. CONCLUSIONS: Much of the literature pertained to programme evaluations of academic activities, and did not compare interdisciplinary education with traditional methods. Many questions about when to educate, who to educate and how to educate remain unanswered and open to future research.     

Developing end-of-life interdisciplinary programs in universitywide settings

Interdisciplinary programs in end of life are widely discussed as valuable, particularly approaches to end-of-life care. Despite this emphasis, interdisciplinary programs have not been easy to implement. In universities, the implementation of interdisciplinary programs encounters administrative obstacles, including credit for the time spent in these group efforts and "ownership" of interdisciplinary courses (IDCs). This article details the process of development and the activities of an end-of-life interdisciplinary program at one urban university with a major medical center. The issues faced in the first year are examined. These included trust, group identity, and communication. The lessons from the first-year activities are presented and efforts of the second year described.     

Voices from the Field — A Qualitative Analysis of Classroom, School, District, and State Health Education Policies and Programs

This study provides a qualitative analysis of responses from classroom-, school-, district-, and state-level educators and administrators to open-ended questions about school health education. These questions were posed as part of the School Health Policies and Programs Study (SHPPS), conducted by the Centers for Disease Control and Prevention in 1994, and elicited a range of responses about the status of school health education programs and factors that facilitated and hindered the delivery of such programs. To improve school health education in the United States, respondents cited the need to increase the value and priority of health education in the school curriculum and advocated for 1) professional preparation in health education for persons teaching health-related courses, 2) health education course curricula to address important and timely issues, 3) student testing in health education, 4) improved resources and support for health education, and 5) increased communication and collaboration within their schools and communities related to health education.     

Changes in students' perceptions of interdisciplinary practice reaching the older adult through mobile service delivery

This study examined students' perceptions of interdisciplinary health care practice in a facilitated, community-based practicum experience. Students' perceptions of interdisciplinary practice relative to their own profession and other health disciplines were examined before and after involvement in mobile service delivery to the older adult in a collaborative team approach. The Interdisciplinary Education Perception Scale was used to collect data before and after planned and facilitated interdisciplinary experiences of students enrolled in health professional programs (nursing, dietetics, physical therapy, occupational therapy, pharmacy, health education, social work, and physician assistant). Univariate repeated-measures analysis of variance revealed significant pretest to posttest and discipline effects following the interdisciplinary interaction of students in the practicum experience. Univariate analysis revealed a significant change in students' perceptions of professional competence and autonomy, actual cooperation and resource sharing within and across professions, and understanding of the value and contributions of other professionals from pretest to posttest. The findings support the need for educators to facilitate communication through innovative interdisciplinary clinical opportunities for health professions students to influence perceptions that promote active participation in a team approach to care delivery in an increasingly complex health care system.     

Interdisciplinary collaboration within Quebec Community Health Care Centres

Central to the success of many recent health system reforms is the implementation of new primary health care delivery models. The central characteristic common to these new models usually emphasises interdisciplinary collaboration. Using empirical research, this paper studies interdisciplinary collaboration among various groups of professionals within an original Canadian primary health care delivery model, the Quebec Community Health Care Centres (CCHCs). The entire population of more than 150 CHCCs have been surveyed. The goals of this study are (1) to measure the achieved intensity of inter-professional collaboration among Quebec CHCCs, and (2) to identify the organisational and professional factors fostering or limiting interdisciplinary collaboration. The results show that Quebec CHCCs have reached modest results in achieving interdisciplinary collaboration especially since interdisciplinary collaboration is a central objective that has been pursued for more than 25 years. This study demonstrates that the main factors associated with interdisciplinary collaboration are closely linked to work group internal dynamics. Interdisciplinary collaboration is linked to the simultaneous and antagonistic effect of some central intragroup process factors. Conflicting values and beliefs are present that both enhance and limit interdisciplinary collaboration. The presence of conflicting stimuli seriously undermines the strength of the CHCC work group's shared beliefs and strongly limits interdisciplinary collaboration. The results also stress the importance of administrative formalisation initiatives to enhance collaboration among different professions. The efficacy of formalisation in this context is based on its capacity to offer an articulated and operative interdisciplinary framework that can generate a counteractive effect to the traditional professional framework. It offers concrete rules that help align the work group beliefs with interdisciplinary values. The formalisation of functions and processes appears thus to be an interesting means to further interdisciplinary collaboration.     

2008年我国省市两级健康教育机构能力建设现况调查

目的了解2008年省市两级健康教育机构能力建设现况。方法采用《2008年全国健康教育业务工作调查表》对全国省级和市级健康教育机构进行问卷调查,调查内容包括机构设置、人员构成和能力建设等。结果全国34个省级健康教育机构中,有13个省级健康教育所为独立建制;428个地市级地区中,419个设有健康教育机构,机构设置率为97.89%。省市两级健康教育专职人员共2695人,其中省级616人,市级2079人。两级健康教育机构共培训4576次,执行国际合作项目、国家级和省级项目共计679个,在国家级和省级期刊上发表学术论文730篇、发表科普文章2605篇。结论健康教育能力建设是长期的任务,需政府和健康教育机构的不懈努力,要不断加强机构建设、优化健康教育人力资源配置,提高整体素质。     

新型冠状病毒肺炎疫情暴发对中国医学人才培养的启示

目的本文着重分析中国2019新型冠状病毒肺炎(Corona Virus Disease 2019,COVID 19)疫情暴发以来所暴露出来的临床医学、公共卫生人才培养方面的突出问题,并结合国际经验及我国相关现况,就如何加强我国医学人才培养提出解决问题的策略与建议。方法通过新闻媒体报道、发表文章以及政策文件的查询,对此次疫情暴发、传播的影响因素进行系统分析,着重指出我国临床医学、公共卫生人才培养以及队伍建设等方面存在的突出问题。结果我国临床医学生和临床医生普遍缺乏流行病学、传染病和医院感染防控等方面的系统培训;住院医师规范化培训缺乏公共卫生方面的轮转与疾病防控实践;临床医务人员自我防护意识普遍薄弱。结论需进一步完善住院医师规范化培训制度,加强医学生和临床医生的预防医学、流行病学、生物统计、传染病防控和重大疫情防控能力的培养,建立传染病防控培训与演练制度。     

Conceptual models for health education research and practice

Although conceptual models are frequently used to illustrate research questions under investigation, there is a paucity of articles about how to develop conceptual models or their importance to health education research and practice. A number of uses of the term model exist. Therefore, we describe a conceptual model developed to guide health education research or practice as a diagram of proposed causal linkages among a set of concepts believed to be related to a specific public health problem. Although informed by the multicausal models of public health, the conceptual models we describe differ from those models in that they do not incorporate all factors correlated with an endpoint of interest. Rather they show only the small part of the causal web selected for study. Conceptual models differ from theory in that they are not usually concerned with global classes of behavior but with specific types of behavior in specific contexts. They often are informed by more than one theory, as well as by empirical findings. Because of the usefulness of conceptual models in narrowing both research questions and the targets of intervention, we advocate the inclusion of the model development process in public health education research methods courses.     

AIDS education for health care professionals in an organizational or systems context.

Traditionally, health education for practicing health professionals, as well as members of the public, focuses on the individual and relies on changing personal behavior. However, health care for persons with acquired immunodeficiency syndrome (AIDS), and members of their families, mainly is delivered within health and human services organizations. Providing AIDS education for health care professionals in an organizational or systems context shifts the focus from the individual to the group and from changing a person's behavior to offering health care professionals opportunities for interaction. In an organizational or systems approach, they can address patient care issues collectively, share interdisciplinary knowledge, identify problems of common concern, plan coordinated and integrated responses, and provide mutual support. A strategy for planning AIDS education is proposed for key administrators, supervisors, and care providers, who are the gatekeepers, opinion makers, and role models of organizations. Addressing organizational, community, and health care delivery system issues as part of an education program provides a forum for defining problems and a basis for uniting professionals and developing solutions.     

Restructuring the health workforces of the NIS countries: report of an unprecedented multinational conference

Health professionals, educators, and policy-makers in the US and the Newly Independent States met in Tashkent, Uzbekistan, and shared concerns on health workforce planning, access to care, and training. The International Conference on the Health Care Workforce for the 21st Century recognized the scope and interdependence of workforce strategies that must be employed to achieve health reform objectives in the new political system. Specific issues addressed in the conference include health workforce planning; interdisciplinary and multidisciplinary education; primary care, family medicine, and general practice; the supply of physicians; medical education; supply and role of nurses; assessing the competency of practitioners; continuing education and training; the role of professional organizations; accreditation; and international collaboration. Conclusions of the deliberations provide insight into present conditions, prospects for change and how future development assistance can most usefully be targeted.     

Application of the Role Delineation Project "Framework" to a Professional Preparation Program

Using the Framework for the Development of Competency-based Curricula for Entry Level Health Educators, the health education faculty at the University of Alabama at Birmingham reviewed and modified their undergraduate health education professional preparation program. Efforts focused on the five steps of preparation and study, review and organization of Framework subcompetencies, organization of Framework subcompetencies into potential courses, placement of objectives for courses, and revision of schedule and sequence for professional preparation courses. The process produced seven core courses to be required of all health education majors. A master list of subcompetencies and objectives also was developed. Faculty perceived several benefits from participating in the project.     

Die neue Ärztliche Approbationsordnung

Since October 2003 medical education in Germany has been given a new more up-to-date basis, the "New Licensing Regulations for Physicians". They represent a reform of both the structure and the content of medical education making great demands on medical faculties and medical students; e.g. elective courses during the first and second cycles of the curriculum, interdisciplinary courses (so-called 'cross-sectional courses'), practical clinical courses of several weeks in five specialties, and family medicine as an option for choice during the last year are central issues of the reform. The number of state-controlled medical examinations has been reduced from four to two. It is now the responsibility of medical faculties to assess the knowledge, clinical skills and professional attitudes of students with respect to the numerous specialties which are part of medical education. This paper presents the essential innovations and describes the current state of the implementation process. It also points out problems that deserve reconsideration. Although the full implementation of the new licensing regulations is still in progress, it might be said that they have already initiated important changes in medical education in Germany.     

Central Asian republics: a case study for medical education reform

Social, political, and economic changes in the former Soviet Union precipitated both the collapse of a once-centralized medical education system in the region and the development of individual models in its place. In the context of rapid globalization and international concerns about health, this development of "nation-based" models for the structure, content, language, and duration of instruction generated concerns about regional accreditation; workforce planning; student qualifications; residency training; continuing education; and infrastructure, such as access to literature, an adequate clinical training base, and links to certification and licensure. The World Health Organization acknowledges that the development of human resources for health is a complex and key element in reforming health systems. In Central Asia, international donor agencies facilitated the development of a regional council of rectors and a partnership consortium of medical academies as reform vehicles. International medical education organizations provide counsel and share their organizations' models, greatly facilitating the reform progress. The groups work to address both the political and regulatory environment and the professional and academic environment that affect the quality of medical schools. The council of rectors is establishing credibility as a regional nongovernmental organization that can advise governments about workforce planning, budgeting, admissions policies, accreditation, and licensure. The group sponsors faculty development workshops, bringing together regional educators around educational and institutional issues of mutual concern. Partnership academies collaborate to develop institutional and individual professional capacity, focusing on standardized evaluation, structure and content of the curriculum, pedagogy, and leadership development.     

Online course design for teaching critical thinking

Teaching critical thinking (CT) skills, a goal in higher education, is seldom considered in the primary design of either classroom or online courses, and is even less frequently measured in student learning. In health professional education, CT along with clinical reasoning skills is essential for the development of clinical practitioners. This study, measuring CT skill development in an online theory course, supports using a cyclical course design to build higher level processes in student thinking. Eighty-six Masters of Occupational Therapy students in four sections of an occupation-based theory course were evaluated on elements in the Paul and Elder CT Model throughout the course and surveyed for their perceptions in their ability to think critically at course completion. Results of this study demonstrated that the online theory course design contributed to improving critical thinking skills and student's perceived CT skill development as applicable to their future professional practice. In a focus group, eight students identified four effective course design features that contributed to their CT skill development: highly structured learning, timely feedback from instructor, repetition of assignments, and active engagement with the material.