innovation in public health education at ramathibodi medical school 2013.12.12

Innovation in Public Health Education for Medical Students  at Ramathibodi, Mahidol University 

Borwornsom Leerapan, MD PhD  Department of Community Medicine 

Faculty of Medicine Ramathibodi Hospital, Mahidol University WHO-SEARO Regional Meeting, Pattaya, Thailand 

12 December 2013 Pix source: Pinaree Chen, 2nd World Prize (under 9 year-old), One Health Art Contest PMAC 2013  

#1: Changes of learning objectives 

–  What exactly are “public health” concepts and skills that our medical students really need nowadays?  

#2: Changes of learning experiences:  

–  How do we deliver public health education to our  

“Gen Y/Z” medical students?  

#3: Changes in evaluation:  

–  How do we know our students “succeed or fail”? 

Our Innovations? 

What’s “public health” here?” 

Pix source: online.wsj.com 

Some Background: Thailand in 1970s 

Pix Source: www.nationalguard.mil 

Some Background: Thailand in 1970s 

•  In 1967, the Rockefeller Foundation assisted the Faculty of Medicine Ramathibodi Hospital, Mahidol University to found  the Center of Community Medicine 

•  Dr.Aree Valyasevi, Former Dean and Chairman of Pediatrics, Dr.Rachit Buri, Former Dean and Chairman of Medicine Department, and Dr.Prem Buri, Former Chairman of Surgery Department set up the teaching “Community Medicine” for medical and nursing students at Ayudhthaya province, especially focusing on community survey and diagnosis. 

Public Health Challenges 

•  Thailand in 1970s:  

– Limited resources in rural healthcare  

•  Thailand in 2000s:  

– Issues of quality, equity, and efficiency in health systems  

21st Century Medical Education 

Pix source: Frenk et al. (2010) 

Mapping Medicine & Public Health 

Source: Hoffman et al. (2012). A Review of Conceptual Barriers and Opportunities Facing Health Systems Research to Inform a Strategy from WHO. 

Community Medicine Center (1967) 

Academic Home 

Department of Community Medicine (from August 2010 on) 

How to teach it to “Gen Y/Z”? 

Pix source: online.wsj.com 

Our Community Medicine Courses 

•  3rd-Year Community Medicine (required, 5 credits): concept of health and health determinants, health system & health service system, physician roles, health education, health promotion, community capacity, community diagnosis, epidemiology, biostatistics 

•  4th-Year Community Medicine I (required, 5 credits): district health system, hospital services system, health systems research, health economics  

•  5th-Year Primary Care Medicine II (3rd-yr, 5 credits): evidence-based medicine,

concepts of primary care, health promotion: health policy and roles of NGOs 

•  6th-Year: Family and Community Medicine (required, 4 credits): skills in

community hospitals, health systems research projects 

•  Health Services System in Community Hospital (elective, 2 credits): health service system in community hospital 

What Level of Our Teaching? 

• Why  Wisdom  

•  How  Knowledge  

• What,  Who,  When,  Where  Informa8on  

•  Number,  Text,  Picture,  Sound,  etc.  Data  

Fighting ADHD in Medical School 

Pix Source: www.thersa.org/events/rsaanimate/animate/rsa-animate-changing-paradigms 

Recommended treatment: •  Ritalin 

•  Active engagement 

Active Engagement in Group Work 

Active Engagement Outside Classroom 

Active Engagement in the Field 

Active Engagement in Community 

Active Engagement in SDH 

Active Engagement in Ambulatory Care 

Active Engagement in Knowledge Management 

Teaching Methods 

•  Self-directed learning 

•  Team-based learning 

•  Problem-based learning  

•  Task-based learning 

•  Case conference, discussion, oral & poster presentation 

•  Fieldwork in community settings 

•  Working in community hospitals 

•  Site visits: factory, clinic, NGO, etc. 

•  Research projects: epidemiological research, health policy and systems research, clinical tracer, routine-to-research (R2R*), etc. 

How to “evaluate” our teaching? 

Pix source: online.wsj.com 

Evaluation Methods 

•  Formative evaluation; –  Feedback to student’s logbook 

–  Feedback of group process  

–  Assessment of report & presentation 

–  Assessment of individual behaviors in the field trip 

–  Assessment of individual and group performance 

–  Peer assessment 

•  Summative evaluation;  –  Examination: MCQ, SAQ, short essay, individual report, oral

examination 

–  Assessment of research, projects, and case study 

Using Social Media for Formative Evaluation 

Note: 5-level scale of evaluation  

Student’s Satisfaction by Departments 

21st Century Medical Education 

Pix source: Frenk et al. (2010) 

•  We want to develop “change agents” who knows how to get people in health systems involved in solving their own problems.  

•  Now, the question is “how” to evaluate change agents? 

Work in Progress 

•  Teachers’ Capacity Building: 

– Periodic medical education workshops for the faculty members and supporting staffs 

– Monthly meetings for knowledge management, course evaluation, and course development 

Future Challenges 

•  Change agents?? 

•  Time constraints (esp. in teaching blocks) 

•  Longitudinal and integrated community clerkship  

•  Shortage of qualified staffs 

•  Urbanized settings 

•  Global health issues 

•  Standardization of courses among schools 

•  Safety issues in the fieldwork 

•  Budget issues for the fieldwork 

Q & A borwornsom.lee@mahidol.ac.th 

rassamee.tan@mahidol.ac.th 

boonmee.sat@mahidol.ac.th 

Pix source: online.wsj.com  http://www.slideshare.net/borwornsom