Medical education and society.

As health care changes under the pressures of restraint and constraint our vision of the future of medical education should be based on the medical school''s responsibility to the community. The medical school is "an academy in the community": as an academy, it fosters the highest standards in education and research; as an institution in the community, it seeks to improve public health and alleviate suffering. The author argues that to better achieve these goals medical schools need to become more responsible and responsive to the population they serve. Medical schools have been slow to accept fully the social contract by which, in return for their service to society, they enjoy special rights and benefits. This contract requires that medical educators listen to the public, talk honestly and constructively with government representatives and assess the needs and expectations of the community.     

Navigating Cultural Crosscurrents: (Post)anthropological Passages through High School

This article presents a (post)anthropological framework for understanding adolescent coming-of-age in U.S. public high schools. Coming-of-age is conceived as a complex, fluid, seemingly contradictory process of identity formation and community integration in which adolescents representing diverse ethnic, racial, gender, and social class locations navigate myriad conflicting cultural crosscurrents through cultural productions within the institutional structures of their schools as well as economic, kinship, religious, and political domains of community life. A case study of an underachieing Mexican American senior shows how these navigations may open up creative possibilities as adolescents make their passages through high school.     

Institutional objectives for medical education that relates to the community.

The graduate of most medical schools in North America is described as an "undifferentiated physician", but there is no universally agreed upon definition of the term. With the proliferation of subspecialties during the past 30 years, each division or department has its own concept of the undifferentiated physician. The result is strong pressure on curriculum committees to increase curriculum content. The medical faculty of the University of Ottawa used an approach to developing institutional objectives for medical schools that was based on the premise that graduates should possess the knowledge, skills and attitudes of a primary care practitioner in the community, and they accepted an institutional goal and 10 institutional objectives after five revisions of the original proposal. An essential element in the development of the objectives was the use of a list of common medical problems, ranked in order of frequency, as guidelines. The resulting institutional objectives are relevant to current community needs and may be used to project the future needs of the community.     

Linking school biology and community in developing countries

Biological education in developing country schools is, to a large extent, academic, abstract, and oriented toward entrance requirements for higher education. Yet, communities are crying out for help in tackling their development problems—food, water, fuel, health. The paper explores the role of biological education in placing the school in its own local community and the real social-economic environment that surrounds it. Particular reference is made to issue-based biological education in schools as an attempt to bridge the gap between purely academic schooling and education for relevance.     

Social Contact Networks and Mixing among Students in K-12 Schools in Pittsburgh,PA

Students attending schools play an important role in the transmission of influenza. In this study, we present a social network analysis of contacts among 1,828 students in eight different schools in urban and suburban areas in and near Pittsburgh, Pennsylvania, United States of America, including elementary, elementary-middle, middle, and high schools. We collected social contact information of students who wore wireless sensor devices that regularly recorded other devices if they are within a distance of 3 meters. We analyzed these networks to identify patterns of proximal student interactions in different classes and grades, to describe community structure within the schools, and to assess the impact of the physical environment of schools on proximal contacts. In the elementary and middle schools, we observed a high number of intra-grade and intra-classroom contacts and a relatively low number of inter-grade contacts. However, in high schools, contact networks were well connected and mixed across grades. High modularity of lower grades suggests that assumptions of homogeneous mixing in epidemic models may be inappropriate; whereas lower modularity in high schools suggests that homogenous mixing assumptions may be more acceptable in these settings. The results suggest that interventions targeting subsets of classrooms may work better in elementary schools than high schools. Our work presents quantitative measures of age-specific, school-based contacts that can be used as the basis for constructing models of the transmission of infections in schools.     

Malaria education from school to community in Oudomxay province, Lao PDR

School-based malaria education has been shown to be effective for improving the knowledge, attitudes, and practices of school children toward malaria control. However, little has been reported about the effect of such education on communities in developing countries. To evaluate the influence of school-based malaria education on the knowledge, attitudes, and practices of people in the community toward malaria, we conducted a school-based intervention in Oudomxay province, Lao PDR, and compared scores obtained before and after the intervention. Participants were 130 school children in grades 3-5 at two primary schools, 103 guardians of these children, and 130 married women who did not have children in the target grades. The intervention included presentation of a flipchart at home and a 1-day campaign conducted by the school children and aimed at the community. The flipchart presentation was conducted at villages where school children of both primary schools resided. The 1-day campaign was, however, conducted only at one village. Before and after the intervention, we conducted a questionnaire-based survey of community women that pertained to malaria. Our main finding was that, in married women without children in the target grades, particularly those who were presented with the flipchart and participated in the campaign, the scores of the mean knowledge, attitudes and practices were significantly increased 1 month after the intervention. In conclusion, our results suggest that school children can act as health information messengers from schools to communities for malaria control in Lao PDR.     

Creating community from the inside out: A concentric perspective on collective artmaking

ABSTRACT

As the original antidote to social alienation (and its tragic repercussions), community art through its large-scale, public, and collaborative nature has the potential to rebuild a sense of community from the inside out. This concentric notion of community art is addressed at both the individual and classroom level, exploring the origins of community in the social and emotional roots of cognition as well as the potential for initiating a sense of community within the classrooms before extending into schools, districts, and counties. Using an interdisciplinary lens, the author establishes this concentric perspective on community and its contemporary relevance through support from neuroscience, anthropology, sociology, psychology, and educational research, concluding with guidelines for practical application.     

Human genetics teaching in U.S. medical schools.

Information about instruction in genetics was obtained fron 103 of the 107 U.S. four-year medical schools. Seventy-two percent of the schools provide a compulsory course in genetics, but there was great variation in duration, content, departmental responsibility for giving the course, and in the disciplines of those doing the teaching. The variability in the number of hours devoted to teaching genetics was reflected in the competence of the students in giving correct answers to questions on genetics posed by the National Board of Medical Examiners. Electives and continuing education courses on genetics are given by two-thirds and one-half of the schools, respectively; but the subject receives very little attention in departments of preventive, community, or family medicine or in schools of allied health sciences. These findings suggest that genetics has not yet found a natural and comfortable context in the curricula of U.S. medical schools.     

No "Rip Van Winkles" Here: Amish Education Since Wisconsin v. Yoder

This study examines the educational implications of the shift in economic livelihood in a Ohio Amish community since a landmark 1972 Supreme Court decision paved the way for control of their schools. The clash between tradition and economic pragmatism, and their multiple interpretations, has led to diverse educational pathways, including public schools, charter schools, homeschooling, GED programs, and vocational courses. The diverse ways in which the Amish continue to renegotiate social boundaries with their English neighbors suggests the need for more attention to internal diversity in the anthropological study of schooling in so called "folk societies."     

Can Schools Support HIV/AIDS-Affected Children? Exploring the ‘Ethic of Care’ amongst Rural Zimbabwean Teachers

How realistic is the international policy emphasis on schools ‘substituting for families’ of HIV/AIDS-affected children? We explore the ethic of care in Zimbabwean schools to highlight the poor fit between the western caring schools literature and daily realities of schools in different material and cultural contexts. Interviews and focus groups were conducted with 44 teachers and 55 community members, analysed in light of a companion study of HIV/AIDS-affected pupils’ own accounts of their care-related experiences. We conceptualise schools as spaces of engagement between groups with diverse needs and interests (teachers, pupils and surrounding community members), with attention to the pathways through which extreme adversity impacts on those institutional contexts and social identifications central to giving and receiving care. Whilst teachers were aware of how they might support children, they seldom put these ideas into action. Multiple factors undermined caring teacher-pupil relationships in wider contexts of poverty and political uncertainty: loss of morale from low salaries and falling professional status; the inability of teachers to solve HIV/AIDS-related problems in their own lives; the role of stigma in deterring HIV/AIDS-affected children from disclosing their situations to teachers; authoritarian teacher-learner relations and harsh punishments fuelling pupil fear of teachers; and lack of trust in the wider community. These factors undermined: teacher confidence in their skills and capacity to support affected pupils and motivation to help children with complex problems; solidarity and common purpose amongst teachers, and between teachers and affected children; and effective bridging alliances between schools and their surrounding communities–all hallmarks of HIV-competent communities. We caution against ambitious policy expansions of teachers'' roles without recognition of the personal and social costs of emotional labour, and the need for significant increases in resources and institutional recognition to enable teachers to adopt support roles. We highlight the need for research into how best to create opportunities for teacher recognition in deprived and disorganised institutional settings, and the development of more culturally appropriate notions of caring.     

Demonstrating social accountability in medical education

The author considers the University of Toronto''s Health, illness and the Community course for undergraduate medical students, described in this issue by Wasylenki and associates (see pages 379 to 383). Social accountability in medical education demands a community orientation and hence an emphasis on outreach. Medical schools should expand their clinical service to the community, provide community-based residency placements and offer continuing medical education in rural and regional centres. Accountability also requires community involvement in planning and implementing research projects. Placing students in a community setting as part of the curriculum is praiseworthy, but it is not sufficient to ensure social accountability. What is needed now is a more comprehensive acceptance by faculties of medicine of the mandate of community-centred learning, together with well-targeted funding for education and research initiatives.     

Undergraduate geriatric education through community service learning

doi: 10.1111/j.1741‐2358.2010.00444.x Undergraduate geriatric education through community service learning Introduction: Despite the exponential growth of the elderly population worldwide, geriatric education has been a formal component of only a few dental schools’ curricula. Objective: To describe the geriatric community service learning (CSL) component of the professionalism and community service (PACS) module, and to explore a CSL project carried out by a group of first year dental students at a long‐term care facility. Methods: A literature review was performed to present and describe the CSL component of the PACS module. Students’ personal reflections were used to illustrate some of the joys and challenges of experiencing a long‐term care facility environment. Results: The newly developed PACS module combines community service learning with the long‐term care experience. Students develop, apply and evaluate an educational health promotion activity in a long‐term care facility. Conclusions: The PACS module has encouraged students to acquire comprehensive knowledge and awareness of the needs and dynamics of a long‐term care as they collaboratively interacted with personnel from the facility to develop their projects. The authors would like to engage other schools in discussing the need to integrate community‐based geriatric education into their dental curricula.     

Observations on Community School Facilities for the Mentally Retarded and Admissions to Institutions in Ontario, 1954-63

The relationship between community school facilities and first admissions of mentally retarded children to Ontario Institutions was investigated for the period 1954-1963. The number of educable (I.Q. 50-75) mentally retarded children aged 6-16 years in community schools rose consistently (92.1/100,000 population in 1954 to 190.1 in 1963), while first admissions of educable mentally retarded persons aged 5-19 years to Ontario Hospital Schools showed no consistent trend (2.0/100,000 in 1954 and 2.0 in 1963). The number of trainable (I.Q. 20-50) mentally retarded children aged 5-18 years in community retarded children''s schools rose steadily (10.9/100,000 population in 1954 to 42.8 in 1963), while first admissions in this category aged 5-19 years demonstrated no consistent trend (2.6/100,000 in 1954 and 2.2 in 1963).No indication was found that the age distribution of these first admissions had changed from 1954 to 1963. Any effect that increased school facilities might have had in reducing first admissions may have been nullified by the very large demand for a limited number of beds.     

La Ronda in a Spanish Kindergarten Classroom with a Cross-Cultural Comparison to Sharing Time in the U.S.A.

This article examines a common speech event in Spanish schools known as la ronda, in which children present oral narratives of their out-of-school experiences. I argue that the goal of this event is to allow the children and the teacher to build a sense of themselves as a moral community. Despite parallels in organization and content between la ronda and sharing time as described in the U.S. literature, there are important cross-cultural differences that also are discussed and interpreted here.     

Counseling Parents of Retarded Children

Recently pediatricians have become more interested in the retarded child and his family and have come to realize that they have been ill-prepared to face the many problems that continually arise. A basic understanding of the role of parents and their aspirations, coupled with a knowledge of interviewing, techniques will enable them to face these problems with greater assurance. In addition, a knowledge of the community facilities and resources is necessary. This will entail direct contact with schools, parent groups, state hospitals for the retarded as well as state and local agencies which deal with the retarded.     

Influenza transmission in a community during a seasonal influenza A(H3N2) outbreak (2010-2011) in Mongolia: a community-based prospective cohort study

Background

Knowledge of how influenza viruses spread in a community is important for planning and implementation of effective interventions, including social distancing measures. Households and schools are implicated as the major sites for influenza virus transmission. However, the overall picture of community transmission is not well defined during actual outbreaks. We conducted a community-based prospective cohort study to describe the transmission characteristics of influenza in Mongolia.

Methods and Findings

A total of 5,655 residents in 1,343 households were included in this cohort study. An active search for cases of influenza-like illness (ILI) was performed between October 2010 and April 2011. Data collected during a community outbreak of influenza A(H3N2) were analyzed. Total 282 ILI cases occurred during this period, and 73% of the subjects were aged <15 years. The highest attack rate (20.4%) was in those aged 1–4 years, whereas the attack rate in those aged 5–9 years was 10.8%. Fifty-one secondary cases occurred among 900 household contacts from 43 households (43 index cases), giving an overall crude household secondary attack rate (SAR) of 5.7%. SAR was significantly higher in younger household contacts (relative risk for those aged <1 year: 9.90, 1–4 years: 5.59, and 5–9 years: 6.43). We analyzed the transmission patterns among households and a community and repeated transmissions were detected between households, preschools, and schools. Children aged 1–4 years played an important role in influenza transmission in households and in the community at large. Working-age adults were also a source of influenza in households, whereas elderly cases (aged ≥65 years) had no link with household transmission.

Conclusions

Repeated transmissions between households, preschools, and schools were observed during an influenza A(H3N2) outbreak period in Mongolia, where subjects aged 1–4 years played an important role in influenza transmission.     

A School Based Cluster Randomised Health Education Intervention Trial for Improving Knowledge and Attitudes Related to Taenia solium Cysticercosis and Taeniasis in Mbulu District,Northern Tanzania

Taenia solium causes significant economic and public health impacts in endemic countries. This study determined effectiveness of a health education intervention at improving school children’s knowledge and attitudes related to T. solium cysticercosis and taeniasis in Tanzania. A cluster randomised controlled health education intervention trial was conducted in 60 schools (30 primary, 30 secondary) in Mbulu district. Baseline data were collected using a structured questionnaire in the 60 schools and group discussions in three other schools. The 60 schools stratified by baseline knowledge were randomised to receive the intervention or serve as control. The health education consisted of an address by a trained teacher, a video show and a leaflet given to each pupil. Two post-intervention re-assessments (immediately and 6 months post-intervention) were conducted in all schools and the third (12 months post-intervention) was conducted in 28 secondary schools. Data were analysed using Bayesian hierarchical log-binomial models for individual knowledge and attitude questions and Bayesian hierarchical linear regression models for scores. The overall score (percentage of correct answers) improved by about 10% in all schools after 6 months, but was slightly lower among secondary schools. Monitoring alone was associated with improvement in scores by about 6%. The intervention was linked to improvements in knowledge regarding taeniasis, porcine cysticercosis, human cysticercosis, epilepsy, the attitude of condemning infected meat but it reduced the attitude of contacting a veterinarian if a pig was found to be infected with cysticercosis. Monitoring alone was linked to an improvement in how best to raise pigs. This study demonstrates the potential value of school children as targets for health messages to control T. solium cysticercosis and taeniasis in endemic areas. Studies are needed to assess effectiveness of message transmission from children to parents and the general community and their impacts in improving behaviours facilitating disease transmission.     

Being human: Why and in what sense it is morally relevant

The debate on the question of the moral status of human beings and the boundaries of the moral community has long been dominated by the antagonism between personism and speciesism: either certain mental properties or membership of the human species is considered morally crucial. In this article, I argue that both schools of thought are equally implausible in major respects, and that these shortcomings arise from the same reason in both cases: a biological notion of being human. By contrast, I show to what extent being human is morally relevant in a non-biological sense. I establish the living human form as the essential criterion for belonging to the moral community, and defend it against a number of possible objections. This new morphological approach is capable of capturing essential elements of personism and speciesism without sharing their faults, and of reconstructing widespread moral intuitions.     

Education for sexuality—the rˆle of the school

Education for sexuality and healthy relationships should be viewed within a broad context of health education and social education in schools. However, this is not merely a matter for the formal curriculum of a school, but relates to the totality of the experience that young people receive there. The concept of the health promoting school encapsulates tfie formal curriculum, the ‘hidden curriculum’, and the interaction of the school with parents, the community, and other agencies, which can affect the health and well-being of all school users. One cannot view a school's rôle in this area out of the societal context. Research indicates that young people, as they move through their teenage years, get most of their information relating to sexuality from friends and yet they acknowledge that this is not a reliable source. Examples of current knowledge levels and attitudes relating to sexuality and HIV/AIDS are given. The strengths and weaknesses of schools as settings for sex education are explored, and 10 key points for consideration within a school policy on education for sexuality and relationships are proposed.