Context
Medical education has not been immune from forces for globalisation in the contemporary world. At the same time the social accountability of medical schools in addressing local health ...priorities has been emphasised. This paper explores the global–local tension in medical education through a careful selection of key overview papers.
Globalisation
Globalisation in medical education has taken two main forms: economic and altruistic. The former includes licensing curricula, recruiting internationally and establishing ‘offshore’ schools or campuses. Altruistic collaborations focus on the spread of learning and educational innovations. Both forms bring benefits but have been subject to critique for their differential impact and focus on educational inputs rather than outputs.
Social Accountability
Social accountability requires medical schools to direct their activities to local priorities and to serving local health systems. Adoption of the principles of social accountability compels all medical schools to ask questions of their educational programmes and graduate outcomes. However, these are globally interdependent questions and are the intent of some well‐known social accountability collaborations. It is naïve to think that adoption of a social accountability agenda by all medical schools would necessarily reduce global health inequity. A recent Australian example shows that workforce maldistribution, for example, is resistant to even high‐level intervention.
Conclusions
It is yet too early to fully accept that ‘think global, act local can be turned on its head’. There is much research to be carried out, particularly on the outcomes and impacts of medical education. Establishing cause and effect is a challenge, as is determining whether globalisation or localisation can contribute to greater global health equity. If we are ever to resolve the global–local tension in medical education, we need more evidence on the outcomes of what we do, whether globally or locally inspired.
Prideaux shines a light on global vs local tension in medical education, suggesting that we need to determine the outcomes of our programs whether globally or locally inspired.
Objectives Using a novel longitudinal tracking project, this study develops and evaluates the performance of a predictive model and index of rural medical practice intention based on the ...characteristics of incoming medical students.
Methods Medical school entry survey data were obtained from the Medical Schools Outcome Database (MSOD) project implemented in all Australian and New Zealand medical schools and coordinated through Medical Deans Australia and New Zealand, the representative body for the Deans of 18 Australian and two New Zealand medical schools and faculties. The medical school commencement survey collects data on students’ education and family background, including rural upbringing, personal circumstances and scholarships, and on their practice intentions in terms of location and specialty. The MSOD will also allow tracking of medical graduates after graduation. Logistic regression modelling was used to develop a predictive model of rural practice intention. Split‐sample validation was used to gain some insight into the stability of performance of the model.
Results Response rates to the MSOD survey exceeded 90% on average. The model findings confirm and extend previous research examining the association of medical student characteristics with intention to take up rural medical practice. The statistically significant independent factors in the model included students’ rural backgrounds, financial arrangements and intentions regarding specialist versus generalist practice upon graduation. Model performance was good, with an area under the receiver‐operator characteristics curve of 0.86, and reproducible, with an area in a validation sample of 0.83.
Conclusions The model and related index provide important insights into individual factors associated with rural practice intention among students commencing medical studies. The model can also provide a means for optimising the use of scarce medical programme resources, thereby helping to improve the supply of rural medical practitioners. This study illustrates the power and potential of a robust, consistent, systematic longitudinal tracking project.
Medical education reform can make an important contribution to the future health care of populations. Social accountability in medical education was defined by the World Health Organization in 1995, ...and an international movement for change is gathering momentum. Priority community needs are generally not well reflected in existing medical curricula. Medical schools have often been concerned more with prestige, research competitiveness and training doctors for narrow specialist careers in urban areas. Orthodoxies in medical education have been challenged where the gap between a community's health care needs and the availability of doctors has been greatest - notably in rural areas and, in Australia, in Aboriginal communities. At a time of growing crisis in health care systems, the need to focus on addressing health inequalities and delivering effective, affordable, people-centred health care is more important than ever. While change can be enabled with policy levers, such as funding tied to achieving equity outcomes and systems of accreditation, medical schools and students themselves can lead the transformation agenda. An international movement for change and coalitions of medical schools with an interest in socially accountable medical education provide a 'community of practice' that can drive change from within. Author summary
Objective: To provide data on the career trajectories of medical students from rural and remote workforce programs at Flinders University (the Parallel Rural Community Curriculum PRCC and the ...Northern Territory Clinical School NTCS), comparing them with students at the urban Flinders Medical Centre (FMC).
Design: Retrospective postal survey of all 150 graduates who undertook their Year 3 study in the period 1998–2000.
Outcome measure: Associations with career preference, assessed using univariate analyses and multivariate regression.
Results: PRCC and NTCS graduates were more likely to choose rural career paths than graduates from FMC. The odds ratios were 19.1 (95% CI, 3.4–106.3; P < 0.001) and 4.3 (95% CI, 1.2–14.8; P = 0.026), respectively, after adjusting for age and rural background. There was no difference in the specialty choices of graduates of the three programs.
Conclusion: This study provides evidence that clinical attachments designed to increase the rural and remote medical workforce do fulfil this objective.
Objectives: The Deakin University School of Medicine commenced in 2008 as a rurally focused medical school in south-eastern Australia. This research was designed to examine the effectiveness of the ...school's adoption of small regional clinical school settings.
Methods: A retrospective cohort study of the first two cohorts of students was employed to assess academic performance at each of five geographically dispersed clinical training sites, with varying student cohort sizes. The Dundee Ready Education Environment Measure (DREEM) questionnaire provided quantitative data regarding the students' perception of their educational environment. The data were analyzed using univariate and multivariate analyses.
Results: The highest examination scores, and greatest satisfaction with educational environment, were associated with the clinical school that had a small-sized group of students and was not co-located with another medical school. These differences remained after adjusting for multiple potential confounding factors.
Conclusion: The smaller sites appear to have provided superior support for student learning in this new medical school. This advantage diminishes when smaller cohorts are co-located with students from other medical schools. Cohort size and co-location of medical school curricula may be important independent variables for researchers to consider when comparing the results of clinical education innovations in different settings.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Turning a critical lens on the definition of programmatic assessment, Pearce and Prideaux argue that implementation in postgraduate training need not be as difficult as it seems if programs use ...programmatic thinking to connect elements already in place.
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