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Knowledge and skills in community oriented medical education (COME) self-ratings of medical undergraduates in Karachi.

OBJECTIVE: To assess the satisfaction of medical students regarding community oriented knowledge and skills that are proposed to be part of the current undergraduate medical curriculum. METHODS: Competencies listed in the regulations for medical education designed by the Pakistan Medical and Dental Council (PMDC) were used to develop a self-administered questionnaire. Using the questionnaire 220 final year students of 3 public sector medical schools self-rated the knowledge and skills that should be part of the curriculum. For analysis the questions were grouped into courses of Basic, Clinical and Community Health Sciences. Students ranked their perceptions on a Likert scale of 0-4 for each question. Descriptive analysis was done to calculate the proportion of satisfied and dissatisfied students using the median of the highest possible score as the cut off. RESULTS: The analysis of knowledge gained found a greater proportion of satisfied students with the Basic (55.9%) and Clinical Sciences (50.9%) courses than the Community Health Sciences course (45.5%). Analysis of skills acquired uniformly showed a low percentage of satisfied students for Basic (39.1%), Clinical (29.7%) and Community Health Sciences (19.1%). The proportion of students dissatisfied with their knowledge and skills for different courses ranged from 38.2-85%. CONCLUSION: Students perceive that current medical school curricula are unable to meet the required standards. Proper implementation of community oriented curricula is the first step towards effective health care provision.

Clinical Competence↗

Operation safe crossing: using science within a community intervention.

AIMS: To evaluate a large drunk-driving enforcement program at the US/Mexican border to reduce the number of youths crossing the border to drink in Tijuana. This paper also describes the research data used to develop and manage the program. Data from a border breath-test survey were used to dramatize the problem and gain public support for action. The data were also used to help design the enforcement effort and measure progress in reducing the cross-border drinking problem. DESIGN: The number of news events generated around the occurrence of special enforcement efforts were used to measure project activity and to predict changes in the numbers of youths crossing into Mexico, their returning BACs and reductions in alcohol-related crashes during a 3-year period. SETTING: An urban county on the Mexican border. PARTICIPANTS: Underage youths aged 18-20 years and young adults aged 21-30 years residing in San Diego County. MEASUREMENTS: Immigration and Naturalization Services provided population counts of the number of individuals crossing each weekend night from Tijuana into the United States through the San Ysidro border facility. Breath-test surveys of a random sample of these returning crossers provided data on the number of US residents visiting bars and nightclubs in Tijuana and on alcohol consumption at Tijuana bars and nightclubs. Night-time had-been-drinking crash data involving young drivers in several California counties served as an outcome measure of public health and safety. FINDINGS: Analysis of data involving more than 2 million pedestrians returning from Tijuana indicated that the Operation Safe Crossing program reduced the number of late-night crossers by 31.6%. CONCLUSIONS: Effective use of data through media advocacy programs to support an enforcement effort can reduce alcohol-related crashes.

Adolescent↗

Science for the community: assessing mental health after 9/11.

Reactions to the September 11 attacks across the United States were pervasive, and persons throughout the country reported experiences akin to posttraumatic stress disorder (PTSD) in the first week following the attacks. In the New York area, 2 major surveys conducted 4 to 8 weeks after the attacks found that approximately 1 in 10 persons probably met full criteria for PTSD related to September 11. Although tobacco, alcohol, and marijuana use did increase, it was largely among persons already using these substances. The greatest increase, not surprisingly, occurred among persons with PTSD and major depressive disorder. Nationwide during the same time period, rates of PTSD related to September 11 were estimated at 2.7% to 4.3%, a striking finding in that the attacks were witnessed primarily on television outside the New York area. In all studies, having anxiety symptoms or meeting criteria for PTSD was strongly associated with number of hours of television watched on September 11 and in the days afterward. A number of explanations for this new finding are possible. These data can inform our understanding of trauma-related diagnoses, further the evolving diagnostic definitions of the Diagnostic and Statistical Manual of Mental Disorders, and contribute to etiologic models of PTSD. Future directions for postdisaster survey research are briefly discussed.

Adult↗

A developing country's university oriented toward strengthening health systems: challenges and results.

OBJECTIVES: The Aga Khan University in Karachi has a mission to educate leaders and to contribute to the development of health systems for Pakistan amid challenges of scarcity and complexity. METHODS: Its key activities are (1) to design and test urban and rural health system prototypes, (2) to develop faculty in medical and nursing postgraduate community health sciences programs, and (3) to design and implement community-based undergraduate medical and nursing curricula. RESULTS: The university has developed equity-based, cost-effective primary health care prototypes in Karachi slums. With government counterparts it has tested village-, facility-, and district-level interventions in a poor rural district. Federal policymakers have taken models from each for widespread replication. The university is training 49 medical and 19 nursing faculty for postgraduate programs in community health sciences. Most faculty retain institutional leadership positions, including teaching community-based, problem-solving, community health sciences as 20% of the medical and nursing undergraduate curriculum. CONCLUSIONS: The mission and experience of the Aga Khan University in population-based health systems design and health sciences education can guide universities in both developing and developed countries.

Child, Preschool↗

[Assessment of the community health nursing curriculum in relation to the modified Stake curriculum evaluation model].

The modified Stake curriculum evaluation model was implemented in practice to evaluate the Community Nursing Science curricula of three Nursing Colleges and the method used is outlined. Some of the results obtained regarding the model's description matrix are: . students are not familiar with the philosophy of Community Nursing Science; . students doubt their readiness for clinical work directly after training; . only one of the tutors in Community Nursing Science had applicable clinical experience in community nursing; . satisfaction regarding the content and evaluation of Community Nursing Science exists amongst students. The purpose of the evaluation was to identify shortcomings in the curricula and and to facilitate curriculum improvement.

Clinical Competence↗

Regime, phase and paradigm shifts: making community ecology the basic science for fisheries.

Modern fishery science, which began in 1957 with Beverton and Holt, is ca. 50 years old. At its inception, fishery science was limited by a nineteenth century mechanistic worldview and by computational technology; thus, the relatively simple equations of population ecology became the fundamental ecological science underlying fisheries. The time has come for this to change and for community ecology to become the fundamental ecological science underlying fisheries. This point will be illustrated with two examples. First, when viewed from a community perspective, excess production must be considered in the context of biomass left for predators. We argue that this is a better measure of the effects of fisheries than spawning biomass per recruit. Second, we shall analyse a simple, but still multi-species, model for fishery management that considers the alternatives of harvest regulations, inshore marine protected areas and offshore marine protected areas. Population or community perspectives lead to very different predictions about the efficacy of reserves.

Animals↗