Marahatta S B, Sinha N P, Dixit H, Shrestha I B, Pokharel P K
Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.
Kathmandu Univ Med J (KUMJ). 2009 Oct-Dec;7(28):461-9. doi: 10.3126/kumj.v7i4.2775.
A revolution in health care is occurring as a result of changes in the practice of medicine and in society. Medical education, if it is to keep up with the times, needs to adapt to society's changing attitudes. Presently medical education has been criticised for its orientation and insensitivity to people's need. The MBBS curriculum of medical institutions of Nepal has been focusing on community-based approaches and is still guided by the same notion. The question put forward is whether it has been appropriate to nurture the present health needs and aspiration of people.
The objective of the present study is to review the existing community based medical education in health institutions of Nepal to strengthen the components of community care.
Qualitative study was done by reviewing the curricula and existing community medicine courses/activities in MBBS curriculum of Institute of Medicine (IoM)/Tribhuvan University, BP Koirala Institute of Health Sciences (BPKHIS) and Kathmandu University School of Medical Sciences (KUSMS).
The curriculum of all the health institutions have addressed significantly on community medicine practice. As per Institute of Medicine, the community medicine practice is achieved through community based learning experiences like community diagnosis, concurrent field with families of sick members and district health system management practice. In BP Koirala Institute of Health Sciences, community medicine practice is undertaken through exposure to community diagnosis program, health care delivery system, family health exercise, applied epidemiology and educational research methodology, management skills for health services and Community Oriented Compulsory Residential Rotatory Internship Program (COCRRIP). In KUSMS, community medicine module is carried out as- community diagnosis program, community health intervention project, school health project, occupational health project, health delivery system functioning, family health care activities and Compulsory Residential Rotatory Internship Program in outreach clinics. In the practice the practical aspects are largely unstructured that waste too much time in non-educational activities and rely on learning and doing. Meanwhile, expectation of the community is increasing and the challenge of nurturing their demands has come in forefront. Community has perceived that the medical schools are concentrating on fulfilling the demand of their curriculum rather directing on their health care need.
Health institutions need to be accountable to take the responsibility of strengthening the health status of the community of their catchments areas. The practice of community medicine need to be done in an innovative way and these schools should execute continual intervention activities and complement other institutions working in their areas.
由于医学实践和社会的变化，医疗保健正在经历一场革命。医学教育若要与时俱进，就需要适应社会不断变化的态度。目前，医学教育因其方向以及对人们需求的麻木不仁而受到批评。尼泊尔医疗机构的医学学士课程一直侧重于基于社区的方法，并且仍然受此观念的指导。提出的问题是，培养人们当前的健康需求和愿望是否合适。
本研究的目的是回顾尼泊尔医疗机构中现有的基于社区的医学教育，以加强社区护理的组成部分。
通过审查医学研究所（IoM）/特里布万大学、BP柯伊拉腊健康科学研究所（BPKHIS）和加德满都大学医学院（KUSMS）医学学士课程中的课程设置以及现有的社区医学课程/活动，进行了定性研究。
所有医疗机构的课程都在很大程度上涉及了社区医学实践。根据医学研究所的说法，社区医学实践是通过基于社区的学习经历来实现的，如社区诊断、与患病成员家庭的同步实地调研以及地区卫生系统管理实践。在BP柯伊拉腊健康科学研究所，社区医学实践是通过参与社区诊断项目、医疗保健提供系统、家庭健康实践、应用流行病学和教育研究方法、卫生服务管理技能以及社区导向的强制性住院轮转实习项目（COCRRIP）来进行的。在KUSMS，社区医学模块包括社区诊断项目、社区健康干预项目、学校健康项目、职业健康项目、卫生服务系统运作、家庭医疗保健活动以及在外展诊所的强制性住院轮转实习项目。在实践中，实际操作方面很大程度上缺乏系统性，在非教育活动中浪费了太多时间，并且依赖于边学边做。与此同时，社区的期望在增加，满足他们需求的挑战已成为首要问题。社区认为医学院校专注于满足课程要求，而不是直接关注他们的医疗保健需求。
医疗机构需要承担起加强其服务区域内社区健康状况的责任。社区医学实践需要以创新的方式进行，这些学校应该开展持续的干预活动，并与在其区域内工作的其他机构相互补充。
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