Pálsdóttir B, Neusy A-J, Reed G
Global Health Education Consortium, San Francisco, CA, USA.
Educ Health (Abingdon). 2008 Jul;21(2):177. Epub 2008 Aug 26.
To date, traditional biomedical hospital-centered models of medical education have not produced physicians in quantities or with the competencies and commitment needed to meet health needs in poor communities worldwide. The Global Health Education Consortium conducted an initial assessment of selected medical education programs/schools established specifically to meet these needs. The goals of this assessment are to determine whether there is a need for and interest in collaborating and developing a common framework of core principles and evaluation standards to measure the impact of the programs on access to care and on health status in the communities they serve.
A literature review of 290 articles was conducted focusing on standards, tools and multi-institutional evaluation efforts of socially accountable medical education programs designed to increase the number of doctors in underserved communities. Site visits, which included semi-structured interviews with deans, faculty and students, were carried out at eight schools on five continents, whose core mission is self-described as training to meet the needs of the underserved. Preliminary findings form the framework around which a rigorous outcome and impact evaluation tool will be developed by participating schools.
No systematic international evaluation of socially accountable medical schools was found and current tools to measure the social responsiveness of programs need more rigor. All target schools identified a need to develop common evaluation and collaborative frameworks. Preliminary findings suggest that these schools, although operating in different contexts and employing somewhat different strategies, share common principles and a core mission to serve marginalized communities.
There is a clear need for a common rigorous evaluation tool for socially accountable medical education, particularly for schools created to address the shortage of doctors in neglected areas. While it will be difficult to determine the impact of socially accountable medical education on health outcomes, target schools agreed to collaborate and develop a common evaluation framework to strengthen the evidence base on how to train doctors to meet health needs in underserved area.
迄今为止，以医院为中心的传统生物医学医学教育模式，在培养数量足够、具备满足全球贫困社区健康需求所需能力和奉献精神的医生方面，成效欠佳。全球健康教育联盟对专门为满足这些需求而设立的部分医学教育项目/学校进行了初步评估。此次评估的目标是，确定是否有必要以及是否有兴趣合作制定一套核心原则和评估标准的通用框架，以衡量这些项目对其所服务社区的医疗服务可及性和健康状况的影响。
对290篇文章进行了文献综述，重点关注旨在增加服务欠缺社区医生数量的社会问责制医学教育项目的标准、工具和多机构评估工作。在五大洲的八所学校进行了实地考察，包括与院长、教师和学生进行半结构化访谈，这些学校的核心使命自我描述为培训以满足服务欠缺人群的需求。初步研究结果形成了一个框架，参与学校将围绕该框架开发一个严格的成果和影响评估工具。
未发现对社会问责制医学院校进行系统的国际评估，目前衡量项目社会响应能力的工具需要更加严谨。所有目标学校都确定需要制定通用的评估和合作框架。初步研究结果表明，这些学校虽然所处环境不同，采用的策略也略有不同，但都有共同的原则和服务边缘化社区的核心使命。
显然需要一个针对社会问责制医学教育的通用严格评估工具，特别是针对为解决被忽视地区医生短缺问题而设立的学校。虽然很难确定社会问责制医学教育对健康结果的影响，但目标学校同意合作制定一个通用评估框架，以加强关于如何培训医生以满足服务欠缺地区健康需求的证据基础。
