158 muster2014 larkins the net
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The document discusses a study of medical student cohorts from schools aiming for social accountability. The schools used selection strategies like quotas for underserved populations and evaluating personal attributes. Their student populations more closely matched local populations compared to traditional schools. Students from rural areas were more likely to intend working with underserved groups. Following graduates' actual practice is needed to assess the impact of selection strategies on health workforce distribution.
![References
Boelen C. (2000) Towards Unity for Health. Challenges and opportunities for partnership in health development. World Health Organization
Boelen C and Woollard R (2009) Social accountability and accreditation: a new frontier for educational institutions. Medical Education 43(9):887-894
Frenk J, Chen L et al (2010) Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet. 376 (9756):1923-1958
Global Commission on Social Accountability Report [online]
Larkins S, Preston R, et al (2013).Measuring social accountability in health professional education: development and international pilot testing of an Evaluation Framework. Medical Teacher. 35 (1): 32-45
Larkins S, Michielsen K, Iputo J et al (2014). Impact of selection strategies on representation of underserved populations and intention to practise: international findings, Doi: 10.1111/medu.12518
Medical Deans Australia and New Zealand. Medical Schools Outcomes Database, Commencing Medical Students Report, 2012. Melbourne: MDANZ; 2013.
Morales Suarez, I et al (2008) Cuban Medical Education: Aiming for the Six-star doctor. MEDICC Review, Fall Vol 10 No 4, 5-8.
Murray R, Wronski I (2006). When the tide goes out: health workforce in rural, remote and Indigenous communities. Medical Journal of Australia. 185 (1): 37-38
Murray R, Larkins S, Prideaux D, Ewen S, Hanks H (2012). The medical school as an agent of change: socially accountable medical education. Medical Journal of Australia.196 (10) doi: 10.5694/mja11.11473
Palsdottir, Neusy, Reed (2008) Building the evidence base: networking innovative socially accountable medical education programs. Education for Health. 21:2.[online]
Strasser R and Neusy A-J (2010) Context counts: training health workers in and for rural and remote areas. WHO Bulletin 88: 777-782
The Training for Health Equity Network. THEnet’s Social Accountability Evaluation Framework Version 1. Monograph I (1 ed.). The Training for Health Equity Network, 2011. www.thenetcommunity.org.
Youngclaus, J., Fresne, JA. (2013) Physician education debt and the cost to attend medical school. 2012 Update Association of American Medical Colleges [online]](https://image.slidesharecdn.com/158muster2014larkinsthenet-141126210631-conversion-gate02/85/158-muster2014-larkins-the-net-21-320.jpg)
158 muster2014 larkins the net
- 1. The development and implementation of an international student and graduate outcome cohort with medical schools aspiring to social accountability A/Prof Sarah Larkins, Dr Kristien Michielsen, Prof Jehu Iputu, Prof Salwa Elsanousi, Dr Marykutty Mammen, A/Prof Lisa Graves, Prof Sara Willems, Prof Fortunato Cristobal, Dr Rex Samson, Dr Rachel Ellaway, Ms Simone Ross, Ms Karen Johnston, Prof Anselm Derese, Prof André-Jacques Neusy For the Training for Health Equity Network
- 2. Faculty/Presenter Disclosure Slide 1 • Faculty: Sarah Larkins, Simone Ross are faculty of JCU. All authors have university affiliations • Relationships with commercial interests: No relationships with commercial interests to declare THEnet receives funding from Atlantic Philanthropies and the Build Foundation
- 3. • Current medical education models often failing to produce an appropriate health workforce (Bulletin of WHO, 2010) • Both a shortage of health practitioners and maldistribution (Strasser and Neusy 2010) • Geographic mismatch between areas of greatest burden of disease and location of medical schools/doctors (Frenk et al) • Traditional selection strategies favour the privileged What are the issues?
- 4. • Growing community of practice • Currently 12 medical schools from 9 countries • Strive to reduce health inequalities through provision of socially accountable medical education • Key strategy: recruit learners from underserved communities as they are more likely to return and address local health priorities Training for Health Equity Network
- 5. Underlying logic Analysis of need •Needs assessment in partnership with stakeholders Core activities of School •Teaching, research and service activities oriented to priority health needs of underserved populations •Partnerships important Improved outcomes •“Fit for purpose” health workforce (contributing to UHC) •Better health outcomes/Increased health equity •Strengthened health systems This is an iterative process
- 6. How does our School work? •What do we believe in? •Who do we serve? (Reference Populations) •What are the needs of these populations? •What are the current and future needs of the health system? •How do we work with others? •How do we make decisions? (Governance) What do we do? •How do we manage our resources? (Resource Allocation) •What, where and how do we teach? •Who do we teach? •Who does the teaching? •How do our research activities address health and health system needs? •What contribution do we make to the delivery of health services? What difference do we make? •Where are our graduates and what are they doing? •What difference have we made to our reference populations? •What difference have we made to our health system? •How has our research affected policies? •How have we shared our ideas and influenced others? •What impact have we had on other schools? (Larkins et al, Medical Teacher 2013)
- 7. Aims 1. What are the selection strategies used by medical schools aspiring to social accountability? 2. To what extent are underserved populations represented in these student cohorts? 3. What are the practise intentions of these medical students? *Definition of underserved
- 8. Methods • Prospective cohort study – first stage cross- sectional questionnaire of commencing students • Developed based on MSOD survey • Student background and practise intentions • Modified for international context • Bivariate comparisons, χ2 tests, proportions with 95% CI and odds ratios • Comparison data from other medical schools using standard selection criteria
- 9. Findings: Participants (n=944) Medical school Participants (Response rate %) Mean age Female (%) Lowest 2 quintiles SES (%) JCU (Australia) 219/238 (93%) 19.9 61.8 29.7 Walter Sisulu (SA) 225/230 (98%) (100 2012 + 125 2013) 21.2 61.4 74.5 Gezira (Sudan) 234/270 (87%) 18.7 59.0 26.7 Ghent (Belgium) 221/266 (83%) 19.3 63.3 8.9 ADZU (Philippines) 45/48 (96%) 22.0 61.7 28.6
- 10. Findings: Selection strategies Selection strategy Medical school Example Quota University of Gezira, Sudan 50% places reserved for students from underprivileged areas of Gezira Quota Walter Sisulu University, SA 80% indigenous African with 75% from rural areas of the Eastern Cape Personal attributes Walter Sisulu University, SA Personal attributes measured equal to academic achievements Community involvement Ateneo de Zamboanga, Philippines Involve two community members on selection interview panel School marketing Ghent University, Belgium Marketing of community-based and –engaged curriculum to attract specific students Overrepresentation of students from lowest two quintiles
- 11. Findings: Socioeconomic background • Combined schools: 29% of 588 students self- reported SES from the bottom two income quintiles compared with 9% in the United States (OR 4.2; P<0.001) (Youngclaus & Fresne 2013)
- 12. Findings: Rural background • Overall, 70% of 817 participants (domestic students) were from a rural origin (defined as majority primary schooling at rurality quintiles 2-5) 0102030405060708090100Ateneo deZamboanga, PhilippinesGeziraUniversity, SudanGhentUniversity, BelgiumJames CookUniversity, AustraliaWalter SisuluUniversity, South AfricaAll AustralianUniversities* Participants (%) Urban originNon-urban origin • Odds ratio for being of rural origin for JCU 3.31 compared with all Australian medical students (p<0.0001) • JCU twice as likely to identify as Indigenous (3.7% vs 1.9%)
- 13. Findings: Practise intentions • Significant association between non-urban origin and intention to work with Indigenous and rural and remote populations (χ2 6.572, df=1, p=0.01; χ2 18.027, df=1,p=0.000)
- 14. Findings: Practise intentions • Inverse association with intention to practise abroad (χ2 for trend 16.025, df=4, p=0.003)
- 15. Conclusions and implications • THEnet partner schools using a variety of selection strategies appear to have a student population that more closely matches reference population when compared with traditional schools. • Suggests that rurality of origin predicts intending to work with rural and remote and other underserved populations. • Selection processes important • Need to follow in terms of actual practise
- 16. Larkins et al 2014. Medical Education Doi:10.1111/medu.12518
- 17. Where to from here? • Continue to collect data from partner schools upon entry and exit and postgrad • Longitudinal study of placements and outcomes • Comparison with mainstream schools • Qualitative exploration of effect of education on attitudes and intentions
- 19. What might it look like in Action? “...we find meaning in what we do; we find purpose in what we do. That is basically what the school is trying to embed in us…” medical student, Zamboanga Questions? sarah.larkins@jcu.edu.au aj.neusy@gmail.com www.thenetcommunity.org
- 20. Acknowledgements • JCU colleagues – Professor Richard Murray – Professor Tarun Sen Gupta – Ms Robyn Preston • THEnet colleagues – Dr Fortunato Cristobal – A/Prof Jusie Lydia Siega-Sur – Professor Khaya Mfenyama – Professor Roger Strasser – Professor Paul Worley – And others from partner schools!
- 21. References Boelen C. (2000) Towards Unity for Health. Challenges and opportunities for partnership in health development. World Health Organization Boelen C and Woollard R (2009) Social accountability and accreditation: a new frontier for educational institutions. Medical Education 43(9):887-894 Frenk J, Chen L et al (2010) Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet. 376 (9756):1923-1958 Global Commission on Social Accountability Report [online] Larkins S, Preston R, et al (2013).Measuring social accountability in health professional education: development and international pilot testing of an Evaluation Framework. Medical Teacher. 35 (1): 32-45 Larkins S, Michielsen K, Iputo J et al (2014). Impact of selection strategies on representation of underserved populations and intention to practise: international findings, Doi: 10.1111/medu.12518 Medical Deans Australia and New Zealand. Medical Schools Outcomes Database, Commencing Medical Students Report, 2012. Melbourne: MDANZ; 2013. Morales Suarez, I et al (2008) Cuban Medical Education: Aiming for the Six-star doctor. MEDICC Review, Fall Vol 10 No 4, 5-8. Murray R, Wronski I (2006). When the tide goes out: health workforce in rural, remote and Indigenous communities. Medical Journal of Australia. 185 (1): 37-38 Murray R, Larkins S, Prideaux D, Ewen S, Hanks H (2012). The medical school as an agent of change: socially accountable medical education. Medical Journal of Australia.196 (10) doi: 10.5694/mja11.11473 Palsdottir, Neusy, Reed (2008) Building the evidence base: networking innovative socially accountable medical education programs. Education for Health. 21:2.[online] Strasser R and Neusy A-J (2010) Context counts: training health workers in and for rural and remote areas. WHO Bulletin 88: 777-782 The Training for Health Equity Network. THEnet’s Social Accountability Evaluation Framework Version 1. Monograph I (1 ed.). The Training for Health Equity Network, 2011. www.thenetcommunity.org. Youngclaus, J., Fresne, JA. (2013) Physician education debt and the cost to attend medical school. 2012 Update Association of American Medical Colleges [online]
- 22. Findings: Practice intentions • MSOD survey indicates 68% of Australian medical students intend to practice in a capital city compared with 25% at JCU