Developing service-based teaching in health education for medical students

Abstract

In the expanding concern about the social-behavioral aspects of health care in medical education, health education has opportunities for making itself an important part of basic medical training. The need is to actually define a physician's appropriate educational tasks and competencies as a basis for curriculum development in health education which would ideally be integrated into the whole educational program. This case study presents efforts to develop an educational service component at a rural health center which, connected to a major teaching hospital, serves as a learning base for medical students. Through trial and student feedback a program has been developed which includes patient counseling, evaluative home visits, group education sessions, exit interviews, medication counseling, community needs assessment and educational consultation with local school teachers. With this program as a foundation, the goal is to integrate health education learning throughout the rest of the medical curriculum.

PIP: This case study reports an effort to incorporate health education into medical teaching: the intent is to provide a sound basis both in health education practice and medical education with the hopes of a broader institutional involvement in the future. For the past 15 years, the Faculty of Medicine, University of Ibadan, Nigeria, has maintained a rural health component of its medical curriculum in the form of a rural health center and district health program sponsored jointly by the University and the Oyo State government. A teaching program has been built around the health center. Approximately 30-40 students are present at any 1 time. Health education has been a nominal part of the program for most of its 15 years. Efforts to develop the current health education service and teaching program were initiated in June 1977. During the intervening year, 6 postings of medical students have passed through the project. Development of the health education program at the rural health center has been based on 3 premises: good teaching in medicine is service based; learning should be experiential; and the experiences should be relevant to the educational duties which physicians undertake. The basic competencies on which this program is based are: individual patient education; group patient education; educational aspects of service design; community health education; and school health education. The 4 components of the health education training program were developed from these competencies. The program components are as follows: clinic based health education; school health education; community health education; and weekly health education seminar. The present staffing pattern can be said to be functional but not ideal. The patient education component has been integrated into the overall clinic services. Home follow-up is conducted once a week on student selected cases, generally 3 or 4 days after the clinic visit. Group patient education activities occur each morning before the physicians begin consulting. The exit interviews have provided students with an opportunity to identify many problems. The program's community health education aspect is the least developed at this point, due to short supply of staff and transportation. 3 forms of evaluation have been used to measure student progress. Direct observation during patient education, group education, and home visits is fed back immediately to improve student performance. An objective test is also given to assess the keenness of educational diagnostic abilities. The objective test and opinion questionnaire results show positive gains in student knowledge and attitudes although not at a significant level.