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Higher education and health professions education: shared responsibilities in engaging societal issues and in developing the learned professional.

Higher education and, in turn, health professions education are being buffeted by a multiplicity of external and internal forces. Issues related to fiscal constraints, higher education's crisis of values and the teaching/research and educational outcomes dilemmas are explored. The increasing accountability of higher education by its public, including measures of institutional effectiveness exacerbate these forces. Health professions education programs and their parent universities and colleges must take better advantage of their respective resources and become united around central educational paradigms and outcomes. The ability of higher education and health professions education to engage and connect to societal issues is critical to the appropriate education of the student and to institutional survival. By interweaving the philosophy and culture of the university or college setting in the fabric of health professions education and particularly dental education, an environment could be created that results in a true learning institution. That is, one in which students and faculty learn together in all settings. The outcomes of such engagement are shared responsibilities and the creation of the learned professional, one who is connected to the world and is not trapped by parochial knowledge. Thus, the continuum of health professions education transcends technical and cognitive achievement but addresses core societal values as well. This paper then explores some of the factors impacting upon higher education and assesses their influence on the nation's health professions schools, and, specifically, colleges of dental medicine.

Education, Dental↗

Community partnership model for health professions education.

Many health professions schools have neglected the US population's health by emphasizing acutely ill patients in hospitals, biomedical research of disease, and high technology. Because most students will eventually fill practitioner roles in primary and secondary care, it is logical that the health professions must shift their curricula's focus to prepare practitioners for the health care needs of the community. The Community Partnership Model is one approach that focuses on public health care needs by educating students in multiprofessional teams in a new organizational structure known as the academic, community-based, primary health care center. This partnership between academic institutions and communities is designed to shift the educational and socializing activities of health professions training outside hospitals to the community setting where research, teaching, and service take place in one structure.

Community Health Services↗

A compendium of higher education opportunities in health professions education.

The authors assembled a compendium of programs world-wide that are dedicated to teaching individuals how to direct, research, or improve the education of health professionals. To accomplish this task, in 1996 and 1997 they interviewed and corresponded with researchers in the health professions and with staffs of faculty development fellowship programs listed in the 1966 Fellowship Directory for Family Physicians, and consulted several postings on the DR-ED listserv. To be included in the compendium, the program had to be specifically focused on health professions education. Out of 51 possible programs, 17 were identified. The authors then sent a questionnaire to the staffs of these 17 programs, asking for program descriptions and information about curricula, students, graduates, costs, and financial aid. Detailed data were received from 15 programs from three continents. Eleven programs offered master's-level degrees and five offered PhD degrees. The majority had flexible study-time arrangements. Graduates of such courses have already assumed leadership position in health professions education and research around the world. The authors hope that their compendium of programs will help guide health professionals who seek to improve their skills in health professions education.

Data Collection↗

Legislative advocacy for health professions educators.

Because much of health professions education in the US is publicly financed, the actions of politicians have profound effects on the organization of health professions education. The success of health professions education programs, therefore, depends in part on the ability of educators to advocate for change in the legislature. Successful legislative advocacy requires a general understanding of the legislative process and the needs of politicians combined with effective communications strategy. The tools of individual legislative advocacy include position papers, letter writing, politician meetings and visits, and using the media. Professional associations advocate on behalf of their members through coalitions, key contact programs, grassroots campaigns, and lobbyists. Successful legislative advocacy depends on credibility and the development of long-term relationships with members of the legislature. The process of legislative advocacy is straightforward and should be viewed as an integral part of health professions education.

Journal Article↗

History of federal legislation in health professions educational assistance in dental public health, 1956-97.

Health professions education assistance in dental public health has been congressionally authorized in one form or another during the last four decades. The US Department of Health and Human Services (and its predecessor, the Department of Health, Education, and Welfare) has been a focal point for managing these federal programs. This report tracks the history of relevant national legislation, beginning in the 1950s with the Health Amendment Acts of 1956 and continuing most recently with the Health Professions Education Extension Amendments of 1992. The number of dental public health professionals trained and available to provide expertise and leadership to improve community oral health status has been tied to the presence and intensity of federal programming in this area.

Education, Dental, Graduate↗

Philosophical considerations in health professions continuing education.

Health professions continuing education is in a state of sprawling disarray. Much of this chaos can be attributed to a lack of clarity regarding its goals and purposes. A historical-philosophical analysis of the aims of continuing education for the health professions provides the basis for clarifying its major goal orientations. Application of this paradigm to practice helps explain underlying variations in the values, beliefs and premises currently characterizing health professions continuing education and can provide sound direction to those responsible for programmatic and policy-making decisions.

Education, Continuing↗

Revisiting the idea of a national center for health professions education research.

The need for a national center for health professions education research is more compelling today than when originally proposed 15 years ago. There is a general consensus as to the need for better assessment of the educational outcomes of U.S. health professions schools, especially in light of the large investment society makes in the health education infrastructure. The author reviews briefly the current state of research in medical education as an example of health professions education research, from both qualitative and quantitative perspectives, and uses the emergence of the teaching academy movement as an example of how innovation in medical education is often implemented (i.e., the "cottage industry approach"). The substantial obstacles facing medical education research are discussed, including significant conceptual, curricular, financial, and outcomes-related challenges. The author proposes the creation and organization of a national center for health professions education research, consisting of four research divisions: basic, translational, applied, and systems. The funding for the center would be derived from a research and development assessment on existing federal investments in health education. The hurdles to the creation of such a center are reviewed and include intellectual, financial/political, and regulatory ones. The author suggests that a national center for health professions education research can be an effective mechanism for the study of many complex issues in health education and health care delivery for which the public desires accountability.

Delivery of Health Care↗

Public policies to promote community-based and interdisciplinary health professions education.

CONTEXT: Many rural and inner-city communities in the United States have persistent shortages of health professionals. In addition, health services are increasingly delivered in community-based settings by interdisciplinary teams. Yet, health professions students in the US continue to receive most of their training in urban hospitals. OBJECTIVE: To assess the extent to which national and state government programs in the US that fund health professions education provide financial resources for community-based and interdisciplinary education in the health professions. METHODS: Literature review. FINDINGS: Most national and state government funding provided to health professions schools and clinical training sites in the US is not targeted to community-based and interdisciplinary education. Nationally, the Bureau of Health Professions, however, does administer some targeted grant programs. In addition, a number of states are addressing these needs through targeted appropriations to health professions schools and Medicaid payments to clinical training sites. RECOMMENDATIONS: The US experience with government funding of health professions education suggests several questions that policymakers in other nations should consider and several principles for developing effective policies to promote community-based and interdisciplinary education.

Journal Article↗

Multidisciplinary education outcomes of the W.K. Kellogg Community Partnerships and Health Professions Education initiative.

This evaluation highlights several points to be considered by others instituting multidisciplinary approaches to health professions education. Community-based, multidisciplinary experiences appear to reinforce support students' interests in pursuing primary care careers. The multidisciplinary, community-based approach to health professions education did not affect academic learning. Project leaders and students reported no risks in terms of board scores between CPHPE students and others in traditional programs. The multidisciplinary, community-based approach to health professions education created opportunities at some sites for students to see "team medicine" in action. It was practical and helped students to understand how they could be more effective in their roles as opposed to competitive. Students require socialization within their own individual disciplines as well as socialization across disciplines. The differences in the structures of traditional health professions education schools interfered with the development of multidisciplinary contexts for learning at some sites. Campus faculty were not necessarily socialized to engage in multidisciplinary efforts. Their disciplines generally do not recognize and reward this behavior. Early and continuous faculty development may significantly help projects to improve communication and develop a better understanding of the contexts of curricular changes across disciplines. This evaluation was exploratory. Further research is needed to better understand what forms of multidisciplinary curriculum are most effective and economically feasible, what forms survive over time, and whether the intended final outcomes of the CPHPE initiative are achieved, not only with medical students but also with the other health professions students.

Curriculum↗

Research approaches in health professions education: problems and prospects.

Research in health professions education has been dominated by a research paradigm emphasizing controlled experimentation. Widespread criticism has been voiced by leaders in the research community concerning the adequacy of the paradigm to deal with complex human behavior occurring in complex social environments. This article is concerned with exploring the implications of controlled studies for health professions education and proposing an alternative research strategy.

Health Occupations↗

Service-learning: community-campus partnerships for health professions education.

In 1995, the Health Professions Schools in Service to the Nation (HPSISN) program was launched under the auspices of the Pew Health Professions Commission as a national demonstration of an innovative form of community-based education called service-learning. The foundation of service-learning is a balanced partnership between communities and health professions schools and a balance between serving the community and meeting defined learning objectives. This article offers a definition of service-learning and an outline of its core concepts; it also describes how service-learning differs from traditional clinical education in the health professions. Further, the author discusses how service-learning programs may benefit students, faculty, communities, higher education institutions, and the relationships among all these stakeholders. The article concludes with brief descriptions of recommended resources for integrating service-learning into the medical school curriculum.

Community Health Services↗

The impact of the Health Professions Educational Assistance Act on state mental health systems.

One effect of the Health Professions Educational Assistance Act of 1976 is to severely limit the number of foreign medical graduates entering the United States. To examine the impact of the law in Michigan, the authors gathered data on the number of psychiatrists practicing in the state and projected future manpower needs. They conclude that it is unlikely that, given other provisions in the law, American medical graduates can numerically replace foreign medical graduates, and that alternative manpower resources will have to be developed. State mental health systems must form new relationships with universities and the private psychiatric sector, and new methods of training personnel and sharing resources must be developed. The authors emphasize the importance of giving state mental health systems sufficient time and resources to develop effective manpower plans.

Education, Medical↗

The case for a national center for health professions education research.

Overall concerns with the health care system have raised important questions concerning educating health professionals. The need to study and perhaps alter the assumptions of this education has been raised, but data on which to base programmatic change have not been generated, since neither the assumptions nor proposed educational innovations have been adequately tested. A national center for health professions education research is proposed to facilitate well-funded, peer-reviewed, and academically credible research in health professions education. The goals of the center would allow for the testing of models to provide physicians and other health professionals with education grounded in sound methodology and content.

Education↗