The potential of neuroscience for health sciences education: towards convergence of evidence and resisting seductive allure

Since emergence of the field ‘Educational Neuroscience’ (EN) in the late nineties of the previous century, a debate has emerged about the potential this field holds to influence teaching and learning in the classroom. By now, most agree that the original claims promising direct translations to teaching and learning were too strong. I argue here that research questions in (health professions) education require multi-methodological approaches, including neuroscience, while carefully weighing what (combination of) approaches are most suitable given a research question. Only through a multi-methodological approach will convergence of evidence emerge, which is so desperately needed for improving teaching and learning in the classroom. However, both researchers and teachers should become aware of the so-called ‘seductive allure’ of EN; that is, the demonstrable physical location and apparent objectivity of the measurements can be interpreted as yielding more powerful evidence and warranting stronger conclusions than, e.g., behavioral experiments, where in fact oftentimes the reverse is the case. I conclude that our tendency as researchers to commit ourselves to one methodological approach and to addressing educational research questions from a single methodological perspective is limiting progress in educational science and in translation to education.     

The institutionalization of public health training and the health sciences

The health of the population is determined by a number of ecological determinants in addition to medical care. Therefore a close relationship exists with the social and political context in a society. With regard to the health care system, schools of public health as institutions for training, research, and services have to focus on four main deficits in the area of information, prevention, social gradients, and the regulation of health care delivery. A task profile derives which comprises (a) training for research and services, (b) monitoring population health and setting of priorities, (c) applied research on public health, (d) consulting the decision makers, and (e) intervention and public accountability. How to perform in these areas has to be related to basic ethical principles, notably, equity, participation, subsidiarity, sustainability, and efficiency. Furthermore, international trends in modern education have to be considered as for the European Union in the Bologna Declaration of 1999, with reference to academization and internationalization of advanced studies. The resulting institutional profile of modern schools of public health is characterized by their academic basis, interdisciplinarity, and multi-professionality. The paradigm of the New Public Health is an equal merger of medical and social sciences, a predominantly postgraduate study program, an international scope, close links to the government, local networks with service institutions, and a focus on contemporary health issues. In the former socialist economies of Central and Eastern Europe a regional collaboration beyond borders (the concept of regionality) is apt to support the achievement of international standards of excellence for newly developing schools of public health.     

Entrepreneurship in health education and health promotion: five cardinal rules

The nature of health education and health promotion (HE/HP) offers a fertile ground for entrepreneurial activity. As primary prevention of chronic diseases becomes a more central component of the health and/ or medical care continuum, entrepreneurial opportunities for health educators will continue to expand. The process used to design, implement, and evaluate health promotion and disease prevention has clear articulation with entrepreneurial, marketing management, and other business processes. Thus, entrepreneurs in HE/HP must be able to utilize business process to facilitate creative, new HE/HP business ideas. The purpose of this article is to weave theory and practical application into a primer on entrepreneurial applications in HE/HP. More specifically, the authors meld their prospective experiences and expertise to provide background thoughts on entrepreneurship in HE/HP and develop a framework for establishing an entrepreneurial venture in HE/HP. Five Cardinal Rules for Entrepreneurs in HE/HP are proposed.     

Prevention and health policy: a view from the social sciences

A theoretical framework is outlined which identifies four major problem areas which must be dealt with in the formulation, implementation, and evaluation of social policy. Certain issues relevant to policy concerning health promotion and disease prevention are discussed within this framework. The first problem area, adaptation, is concerned primarily with resources; the second area, goal attainment, deals with organizational issues; the third, integration, is concerned with motivations; the fourth, pattern maintenance, concentrates on questions of values. Policymaking is seen as an attempt by governing bodies to resolve problems in all these areas, and the success of any policy may be judged by the extent to which major issues in each area are dealt with equitably and reasonably.     

Creating a market in workplace health promotion: the performative role of public health sciences and technologies

The last 20 years have seen the rise of ‘a market’ aiming to promote the vitality and health of employees. In this article, we use insights from Science and Technology Studies to analyze how this market developed, what side effects it has given rise to, and to what extent the market identifies and addresses these side effects. Drawing on an analysis of documents and interviews with stakeholders, we will show that knowledge institutes have played a major role in turning employee health into a commodity. Referring to the health sciences for legitimation, they have developed ‘market devices’ that turn employee health into a commodity. In this commodification process, employees are transformed into an object of care and do not constitute a market party themselves. Privatization of occupational health is accounted for by arguing that market mechanisms will adequately address the health of employees as a public goal. However, subtle mechanisms serve to discipline employees who already display a more or less rationalized lifestyle into vital and fit workers, while threatening to exclude unhealthy employees. These unintended side effects of the market of workplace health promotion are neither identified nor addressed in the market, which – for the time being at least – is thus failing to safeguard the public interest of employee health.     

Stability and change in health insurance among older Mexican Americans: longitudinal evidence from the Hispanic established populations for epidemiologic study of the elderly

OBJECTIVES: This study examined the association between health insurance coverage, medical care use, limitations in activities of daily living, and mortality among older Mexican-origin individuals. METHODS: We analyzed longitudinal data from the Hispanic Established Populations for Epidemiologic Study of the Elderly (H-EPESE). RESULTS: The uninsured tend to be younger, female, poor, and foreign born. They report fewer health care visits, are less likely to have a usual source of care, and more often receive care in Mexico. Conversely, those with private health insurance are economically better off and use more health care services. Over time, the data reveal substantial changes in type of insurance coverage. CONCLUSIONS: The data reveal serious vulnerabilities among older Mexican Americans that result from a lack of private Medigap supplemental coverage.     

Assessing the ability of medical students to apply evidence in practice: the potential of the OSCE

OBJECTIVES: Critical analysis and application of evidence-based practice are key skills for students to master. Assessment of these skills can be undertaken by written examination. Regardless of how knowledge of the appraisal process may be assessed, written examinations ignore assimilation of that evidence into everyday practice. DESIGN: A combined clinical and communication skills station was used in an objective structured clinical examination where the ability to appraise evidence critically was assessed along with the application of that evidence in managing a common clinical problem. SETTING: University of Liverpool. SUBJECTS: Undergraduate medical students. RESULTS: The results from 156 undergraduate medical students demonstrated that it is possible to assess the application of evidence in practice, both in terms of outcome and patient assessment of the encounter. CONCLUSIONS: Assessment is a powerful tool in promoting learning and adoption of such assessment strategies may help to address concerns surrounding apparent poor effect of critical appraisal training.     

Policy sciences, the environment and public health

Human interrelationships with environmental systems and processesdemonstrate complexity far in excess of the intellectual capacitiesof the usual scientific (including social scientific) disciplinesand professions. Indeed this mismatch between practical realitiesin the world around us and our quite limited intellectual tools,theories, and techniques has been widened by fragmentary andparticularistic impulses in the disciplines themselves. Thereare notable exceptions, however, although the common aspectsand links between policy sciences, ecology, and public health—threeexceptions—have not yet been noticed, explored, and developed.This essay begins with the policy sciences and ecology, wherethe case is somewhat clearer, and then proceeds to implicatepublic health in terms of environmental monitoring (especiallyfor human health effects), various and ongoing studies of globalchange, instances of environmental insult, and finally, ecologicalcollapse and reconstitution. Emphasis on the considerable challengesa joining of policy sciences, ecology, and public health portendsruns throughout the essay.