The Integration of Primary Care and Public Health in Medical Students' Training Based on Social Accountability and Community-Engaged Medical Education

Community Preceptors' Views on the Training Needs of Medical Students and Factors Affecting Medical Education in the Community Setting: An Exploratory Study

OBJECTIVES

To identify community preceptors' views on the qualities and abilities required of physicians in community medicine, the education to acquire those qualities and abilities, and the factors affecting preceptors' involvement in community-based teaching.

METHODS

We conducted semi-structured interviews with 13 male community preceptors in northern Japan who had at least 5 years of experience in community medicine and prior teaching experience with preclinical students. Participants were selected using purposive sampling to ensure diversity in clinical roles and institutional affiliations. A thematic analysis was conducted on verbatim transcripts to identify recurring themes.

RESULTS

Participants emphasized "communication skills," "understanding the perspectives and backgrounds of patients and their families," and "love for the community and its people" among the essential qualities and abilities for community physicians. They cited deepening relationships with and fostering an attachment to the community as necessary to cultivate these skills. The factors identified as facilitating community-based teaching included "positive emotions felt throughout the teaching experience," "supporting hospitals and the wider community," and "devotion to students." Factors that hindered involvement included "perceived difficulty of teaching preclinical students" and "education-related issues at universities assigning students on placement," such as the lack of opportunities for community-based teaching within the curriculum.

CONCLUSIONS

In line with the "social axis" in Worley's four Rs model, deep community involvement is essential to developing communication skills and patient-centered medicine. This study identified the qualities and abilities required for community physicians, as well as the educational activities needed to cultivate them from the early years of medical school. Strengthening collaboration between universities and community preceptors is vital to advancing community-engaged medical education (CEME). Cross-cultural studies could further explore how CEME operates in diverse contexts, contributing to socially accountable and community-responsive medical education.

Instilling social accountability into the health professions education curriculum with international case studies: AMEE Guide No. 175

This AMEE guide focuses on instilling social accountability (SA) concept and values into health professions education (HPE) curricula with the goal of producing competent, compassionate healthcare professionals who can act as change agents within the healthcare system. By incorporating SA, HPE schools will instil in their students a strong sense of accountability for addressing the health needs of the communities they serve. This AMEE guide presents a comprehensive framework for embedding SA into the HPE curriculum, covering various aspects in curriculum design, implementation, and evaluation. It also includes case studies of exemplary socially accountable curricula, highlighting the experiences of schools aspiring for SA. Acknowledging how curriculum is embedded in a larger institutional structure, and that SA requires institutional commitment in its governance structure and policies is also a critical component for consideration.

Triple therapy: Three departments collaborating to train medical students in rural settings

The primary healthcare (PHC) rotation places medical students in rural district hospitals for 4 weeks during their 4th or 5th year. This rotation is a collaboration among three academic units at Stellenbosch University's Faculty of Medicine and Health Sciences. Learning activities during this rotation include participation in a longitudinal community-oriented primary care project, conducting rehabilitation-oriented home visits to persons with disabilities, and assessing and treating patients presenting with undifferentiated problems on an in- and outpatient basis. Working in rural contexts for a month affords students opportunities to foster meaningful relationships with the healthcare team, patients and the community, while learning about collaborative teamwork and communities. Critical reflections about the interprofessional care of patients and a community evaluation are key components of the students' learning and assessment. Demonstrating the importance of interprofessional collaboration in PHC, this integrated training model has received, and continues to receive, positive feedback from students and the clinicians involved. Attention to logistics and academic support plays a crucial role in ensuring optimal learning for students. An integrated approach that involves multiple academic units, various healthcare professions and communities is strongly recommended for those who are considering training students in rural PHC environments.

Adoption of a Comprehensive Approach to Overcome the Challenges Involved in the Implementation of Social Accountability in Medical Education: A Brief Review

In the field of delivery of medical education, social accountability envisages the responsibility of medical and healthcare institutions to meet the health-related needs of the communities in the catchment areas. The medical colleges that have integrated social accountability in their curriculum work with a goal to produce not only knowledgeable and skilled medical graduates but also those who are committed to the well-being of the entire community. The process of implementation of social accountability in medical education can have its own share of challenges. There is an immense need to plan and implement potential solutions for each of the identified challenges to ensure maximum benefit to the students, teachers, and community at large. In conclusion, social accountability in medical education has been associated with multiple benefits to all the involved stakeholders. This calls for the need to identify the challenges that can play their part in the successful implementation in medical schools and employment of appropriate measures to overcome them and move thereby bringing about a decline in health disparity.

The role of local health officers in advancing public health and primary care integration: lessons from the ongoing Universal Health Coverage reforms in the Philippines

The COVID-19 pandemic has highlighted the persistent fragmentation of health systems and has amplified the necessity for integration. This issue is particularly pronounced in decentralise settings, where fragmentation is evident with poor coordination that impedes timely information sharing, efficient resource allocation and effective response to health threats. It is within this context that the Philippine Universal Health Care law introduced reforms focusing on equitable access and resilient health systems through intermunicipal cooperation, enhancing primary care networks and harnessing digital health technologies-efforts that underline the demand for a comprehensively integrated healthcare system. The WHO and the global community have long called for integration as a strategy to optimise healthcare delivery. The authors contend that at the core of health system integration lies the need to synchronise public health and primary care interventions to enhance individual and population health. Drawing lessons from the implementation of a pilot project in the Philippines which demonstrates an integrated approach to delivering COVID-19 vaccination, family planning and primary care services, this paper examines the crucial role of local health officers in the process, offering insights and practical lessons for engaging these key actors to advance health system integration. These lessons may hold relevance for other low-ncome and middle-income economies pursuing similar reforms, providing a path forward towards achieving universal health coverage.

A review and analysis of accountability in global health funding, research collaborations and training: towards conceptual clarity and better practice

INTRODUCTION

Accountability is a complex idea to unpack and involves different processes in global health practice. Calls for accountability in global health would be better translated to action through a better understanding of the concept and practice of accountability in global health. We sought to analyse accountability processes in practice in global health funding, research collaborations and training.

METHODS

This study is a literature review that systematically searched PubMed and Scopus for articles on formal accountability processes in global health. We charted information on processes based on accountability lines ('who is accountable to whom') and the outcomes the processes were intended for ('accountability for what'). We visualised the representation of accountability in the articles by mapping the processes according to their intended outcomes and the levels where processes were implemented.

RESULTS

We included 53 articles representing a wide range of contexts and identified 19 specific accountability processes for various outcomes in global health funding, research collaborations and training. Target setting and monitoring were the most common accountability processes. Other processes included interinstitutional networks for peer checking, litigation strategies to enforce health-related rights, special bodies that bring actors to account for commitments, self-accountability through internal organisational processes and multipolar accountability involving different types of institutional actors. Our mapping identified gaps at the institutional, interinstitutional and broader system levels where accountability processes could be enhanced.

CONCLUSION

To rebalance power in global health, our review has shown that analysing information on existing accountability processes regarding 'who is accountable to whom' and 'accountability for what' would be useful to characterise existing lines of accountability and create lines where there are gaps. However, we also suggest that institutional and systems processes for accountability must be accompanied by political engagement to mobilise collective action and create conditions where a culture of accountability thrives in global health.