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During the past decade (1976-1986), both the number of nurse practitioner programs and the federal funding of those programs peaked. The majority of programs now offer a master's rather than a certificate and the orientation of the curriculum changed from treatment of disease to health promotion.
Keeping the curriculum focused on nursing will take the best efforts of nursing educators, administrators, and practitioners. Nursing knowledge based on systematic study has expanded and is now developing more quickly than ever. This, along with the recognized need for general education courses in the curriculum, has helped nursing move into the mainstream of higher education. New approaches to curriculum organization and to teaching nursing should be considered in the effort to provide the best possible education. The many advances made by nursing education and practice in the past century now challenge us to consider curriculum changes that could significantly alter our traditional approaches.
A three-year prospective chart audit of a family practice residency program was performed to measure physician compliance in following the recommendations of an adult immunization program. Despite curriculum changes, performance self-evaluation, and reminders by faculty members to residents about the need for adult immunization, physician compliance was poor in the second year of the study. It was thought that components of the medical record might be improved to facilitate physician compliance in the adult immunization program. At the beginning of the third year of the audit, tetanus and pneumococcal vaccines were preprinted on the health maintenance inventory (HMI), but influenza was not. The chart design also was changed to put the HMI in a more prominent place. In the third year of the audit, physician compliance with tetanus and pneumococcus immunization improved significantly. The results of the chart review suggest that physician compliance with adult immunization programs can be improved with appropriate chart design.
Formal population education is designed to teach children in school about basic population issues and, in many cases, to encourage them eventually to have smaller families. Some programs include specific units on human reproduction and family planning, while others do not. National population education programs began during the 1970s in about a dozen countries, mainly in Asia. These include Bangladesh, India, Indonesia, South Korea, Malaysia, the Philippines, Sierra Leone, Sri Lanka, Singapore, Thailand, Egypt, Tunisia, and El Salvador. A strong case can be made for including an important contemporary issue like population in the school curriculum. Nevertheless, educational innovation is a difficult and long-term process. As a rule, it takes 5 to 10 years before new material can be fully incorporated in a school curriculum. Curriculum changes must be carefully planned, thousands of teachers trained, and appropriate materials prepared for classroom use. Moreover, differences of opinion over the need, acceptability, goals, content, methods, and other aspects of population education have held back programs in some countries. Where population education programs have been implemented, student knowledge of population issues increases, but it is not yet clear whether in-school education has a measurable impact on fertility-related attitudes or behavior.
The Department of Family Medicine at the University of Washington was started ten years ago after a major curriculum change in the medical school placed new emphasis on education and training of family physicians for the surrounding region in Washington, Alaska, Montana and Idaho (WAMI). This department has organized active programs in patient care, teaching and research at the university base and in a number of affiliated community sites throughout the region. The department is well accepted within the mission of the medical school. Almost a third of graduating medical students choose postgraduate training in family practice. Almost 90 percent of the graduates of the ten programs within the department's network of family practice residencies are established in active family practices, with more than two thirds settling in the WAMI region. Follow-up studies show that these graduates feel well prepared for their practices; are providing a broad range of services in rural, suburban and urban settings; are typically involved in partnership or group practice; and are generally well satisfied with their personal and professional lives.
Curriculum changes in medical schools in nonindustrialized countries are being aimed at producing graduates who have a better understanding of the assessment and management of community health problems. The rationale for such changes exists in the context of appropriately balancing a country's limited resources with unmet medical needs in rural and poverty areas. Indonesia's efforts to improve its medical students' qualitative and quantitative participation in community health activities are discussed. Student and faculty problems in the community health program of Udayana University Medical School in Denpasar, Bali, are cited. Knowledge gained from community health programs in Indonesian medical schools should be examined by U. S. medical educators who are seeking to improve the community orientation of American medical students.
BACKGROUND: In 1991, the General Medical Council suggested the development of a new undergraduate curriculum, on a 'core plus electives' basis. The combination of National Health Service reforms and the rising profile of academic departments of general practice had led to a consideration of general practice as an alternative teaching environment. These departments now face escalating expectations from their medical schools of their ability to provide additional community based teaching. AIM: The aim of this study was to investigate the present contribution of academic departments of general practice to undergraduate teaching and their plans for curriculum development, including the introduction of community-based clinical skills teaching. METHOD: A questionnaire was circulated in June 1993 to all academic departments of general practice in the United Kingdom and Eire. RESULTS: Twenty seven out of 28 questionnaires were returned. Twenty two departments provided pre-clinical teaching and all provided a clinical practice attachment. Eight medical schools were organizing community-based clinical skills teaching, and in two this formed the basis for a community-based medical attachment. Eight planned to reduce the factual content of their curricula and introduce problem-based learning while nine were contemplating a 'core plus electives' option. Fourteen medical schools had primary care input in teaching basic clinical skills and an additional seven planned to introduce this. Problems encountered by the general practitioner tutors in teaching clinical skills included insufficient time and resources and poor self-esteem; they identified a need for good central and peripheral organization. CONCLUSION: Compared with a 1988 study, academic departments of general practice are increasingly involved in teaching both general practice and general medical skills at undergraduate level. Curriculum change is occurring rapidly, with an increasing trend towards community teaching; the implications for both academic departments and general practitioner tutors are discussed.
This paper reviews some of the developmental procedures regarding changes in Medical Education within the Faculty of Medical Sciences, University of the West Indies. Discussed are some of the constraints experienced in attempting curriculum changes in the established Medical School at Mona, Jamaica, as compared with the implementation of a Problem-based Learning Strategy curriculum at the Eric Williams Medical Complex, St. Augustine, Trinidad and Tobago. At Mona, integration of disciplines, Community-health and other programmes were attempted. However, it was at the Eric Williams Complex, a new school, that the Faculty of Medical Sciences was able to implement a problem-based programme.
In light of the Canadian Nurses Association's position that the baccalaureate degree would be the requirement for entry to practice by the year 2000, plus evidence of a rapidly changing health care system, changing client characteristics, and on-going economic constraints, administrators of nursing programs in Edmonton recognized the need for a more process-oriented curriculum to prepare nurses to be more capable of facing future challenges. Not surprisingly, limited funds and differing human and material resources meant they could not complete a major curriculum change individually. Collaboration proved to be the key that increased access to baccalaureate nursing education in Alberta.
Several medical schools in Southeast Asia have identified deficiencies in their undergraduate medical education that result in inappropriate training of students for the health-care problems that exist in their respective countries. Curriculum changes have been made that take students out of the laboratory and the subspecialty-oriented university hospital and place them in extramural programs in the community. Both the deficiencies identified and the solutions developed merit study by North American medical educators, especially those teaching primary care in family practice.
A comprehensive, functioning evaluation system is an important component of a residency program. It should focus on the residency program as well as on the residents and should provide feedback to the residents, their teachers, and the program director. Such a system allows residents and their faculty advisors to receive timely, ongoing, formative feedback concerning resident progress. Likewise, it can help the faculty recognize the strengths and weaknesses of the training program by providing data that can lead to the curriculum changes needed to improve resident experiences. Additionally, it can alert the residency program director to residents whose performance is significantly below that of their peers, allowing intensive faculty and advisor help for these individuals. The practical aspects of providing feedback and implementing an evaluation system apply no less to community-based educational experiences than they do to inpatient and outpatient training areas.
The dental literature for the past 30 years, with emphasis on recent publications, was reviewed for articles on trends in dental education. A keyword search of the MEDLINE database identified 6,055 papers, from which those most likely to predict future trends are considered in this article. Particular emphasis is placed on the Institute of Medicine of the National Academy of Sciences 1995 study, "Dental Education at the Crossroads: Challenges and Change." Reactions to this U.S.-based study are also detailed. Trends in curriculum analysis, curriculum change and reform, curriculum length, dental school financing, dental student costs, dental school and university relationships, dental school patient care, dental research, accreditation, oral health and trends from outside North America are documented. In addition, a series of predictions are made, and a brief bibliography of the 51 most relevant references is included.
BACKGROUND AND OBJECTIVES: The educational efficacy of family practice residency behavioral science training and how various educational approaches might influence graduate practice activity are poorly understood. In this study, we compare a traditional didactic and clinical block rotation approach to a problem-based learning (PBL) and clinical, experiential behavioral science curriculum. METHODS: Surveys of pre- and post-intervention cohorts were used to assess graduates' perceptions of their understanding of broad behavioral science concepts, their competence to manage specific behavioral conditions, and their behavioral science practice activity. The two cohorts were University of California, Irvine family practice residency program graduates from 1984-1988 (58) and residency graduates from 1993-1995 (27). American Board of Family Practice (ABFP) In-service Training Examination scores were also compared. RESULTS: No significant differences were detected in self-perceived competence and ABFP examination performance. Residency graduates in the post-intervention cohort more often included depression, marital counseling, and eating disorders in their practice and reported more frequent practice activity for situational stress and sexual dysfunction. The post-intervention group reported less involvement with alcohol and substance abuse problems. This group also reported practice activity that exceeded perceived levels of competence for attention deficit disorder, learning disorders, and eating disorders. CONCLUSIONS: Participants in a PBL-clinical experiential curriculum reported higher levels of practice activity for several common behavioral problems. It seems unlikely that these differences were due to curriculum changes. Further investigation of the influence of educational and other factors on residency graduate practice activity is needed.
The research reported in this article was undertaken to assess the perceptions of health science graduates in the fields of health information management, occupational therapy, orthoptics, physiotherapy, and speech pathology regarding their perceptions of the adequacy of undergraduate preparation in meeting the demands of a changing health care environment. An instrument was devised for use by graduates on the basis of the skills and workplace behaviours specified by experienced practitioners in the above fields as necessary in newly recruited graduates. A total of 527 health science graduates completed the 52 item instrument. The statistical analyses indicated that 11 factors define the adequacy of graduates' preparation for the workplace. Health science graduates perceived themselves to have been more thoroughly prepared on certain workplace dimensions than on others. Specifically, graduates perceived themselves to be ill-equipped on dimensions concerned with workplace management, knowledge of the health industry, and coping in the workplace. Graduates also perceived themselves to be inadequately prepared in terms of communicating with clients, health professionals, and the general public. The strengths of their courses were perceived to be in completing essential tasks, having confidence in the clinical role, in ethical practice, in pursuit and application of knowledge, and having a realistic expectation of the workplace role. The results are discussed in terms of the need to address curriculum changes.
In 1995, the local anesthesia course was combined for dental and dental hygiene students. It was also the first time that dental hygiene students were instructed clinically in local anesthetic techniques. Faculty felt it important to evaluate student attitudes regarding these curriculum changes. This study assessed students' perceptions of the adequacy of background preparation courses, concerns about administering local anesthetics and attitudes about its administration by dental hygienists. A pre/post survey was completed by dental and dental hygiene students. T-tests were used to determine if differences in attitudes existed between groups and if changes in attitudes occurred within groups after taking the course. Results indicated that both groups believed they had adequate background preparation. Apprehensions about administering local anesthetics were similar, but the dental hygiene students felt significantly less anxiety (p < 0.01). Results also differed significantly on the issue of hygienists administering local anesthetics, with hygiene students in support of it and dental students opposed (p < 0.01). Results confirmed that no changes were needed in the existing prerequisite courses for both groups. A need to address student anxiety about local anesthetic administration has been identified. In addition, it may be beneficial to expand dental students' appreciation of dental hygiene education to foster mutually successful working relationships in the future.
This study assessed the current and ideal for dental curriculum emphasis of thirty-three curriculum topic areas and evaluated barriers to curriculum change. A forty-six item survey was mailed to the academic deans of all U.S. dental schools with an 86 percent e response rate (n = 57). The means of their responses for current curricular emphasis and ideal emphasis on the thirty-three topic areas were compared. "Health promotion/disease prevention," "primary care," and "effective patient-provider relationships/communication" were the three topic areas rated most highly (for ideal emphasis) by the academic deans. "Case management," "outpatient/ambulatory care," and "continuous quality improvement" also received high mean scores for ideal emphasis. The most significant barrier to curriculum reform was "an already crowded curriculum." The academic deans reasserted the traditional emphasis in dentistry on primary care. There also appears to be considerable support for educational programs that will foster better patient relationships and greater quality assurance and control.
The "Unified National Health System" of Nicaragua was established in 1979, in an attempt to transform some of Latin America's worst health indices. This system, based on the stated principles of planning, regionalization, public participation, and primary care, has prioritized the development of health professions training programs appropriate to its special needs and principles. Public Health and Epidemiology training was inaugurated in 1982. A new campus of the School of Medicine was opened in 1981, increasing the number of medical students by a factor of five. Formal residency training (never before available within the country) in primary care specialties has been established. Training for allied health personnel has been formalized in several fields, with the establishment of the Polytechnical Institute of Health. The rapid increase in number and size of training programs has created a tremendous need for educational resources both human and material. This article reviews the status of health personnel training in Nicaragua today, the integration of these programs into planning for the health system, and problems arising from their rapid appearance.
The level of knowledge and the opinion about HIV/AIDS problem of 571 students (179 females, 392 males) and 211 teachers (85 females, 126 males) were assessed using an interview-questionnaire. The results explored the little priority given to sex education in Egyptian schools in addition to the very minor role of schools as source of knowledge (about AIDS problem) for students and teachers who revealed much interest towards the problem and wanted to know more about it, reflecting the need for urgent organized health educational programme.