Book Review: Where No Doctor Has Gone Before: Cuba’s Place in the Global Health Landscape

Robert Huish, Assistant Professor at Dalhousie University, Department of International Development Studies, presents an overview of the Cuban health system, the Cuban medical education system, and the government’s effort to provide care beyond its borders. This is a practical book that gives the historical background of how Cuba has survived decades of economic sanctions to become one of the world leaders in universal health care. The author examines the different aspects of Cuban health care using credible evidence and a variety of sources including the author’s own experiences in Cuba learning how health care and medical education is delivered

What Works in Rural Interprofessional Practice and Education? A Study of Student Reflections

Background: Team-based care has been proposed as a way to utilize rural healthcare resources wisely. Thus, the need to educate healthcare profession students in the fundamentals of rural team-based practice has increased in recent years. Thisstudy sought to examine student reflections of a rural interprofessional practice and education (IPE) program in an effort to learn how students described their experience and what they valued. Methods and findings: Student reflection journals from a formal rural IPE program were examined for themes related to post-experience values, attitudes, and beliefs. In general, the time spent in rural IPE led to understanding what it means to live and provide care as a team to a rural community. One important new discovery is that social interactions outside formal IPE curriculum are central to achieving programmatic goals. Conclusion: Understanding the significance of rural IPE and how to guide students both inside and outside the clinical setting will help lead the development of future IPE. The findings of this study shed light on what students valued in a rural IPE experience and, thus, have implications for where institutional resources should be concentrated

Learning by doing: the MD-PA Interprofessional Education Rural Rotation

While much investment has gone into developing interprofessional education (IPE) curriculum for healthcare professional students, many of these efforts have focused on classroom rather than clinical environments. Implementing robust IPE experiences into clinical training is often complicated by obstacles such as differing rotating schedules and differing curricular requirements. The Combined Medical-Physician Assistant Student Rural Rotation (Med-PARR) at the Oregon Health and Science University takes a practical approach to these challenges. Med-PARR students participate in focused IPE activities that overlay, or \u27float\u27, on top of each trainee\u27s profession-specific curricular requirements. Through critical reflection, goal setting, and a community-based project, students get the opportunity to critically reflect on their interprofessional roles while participating in their rural clinical settings. The practical approach of the Med-PARR can serve as a model for other institutions seeking to solve similar logistical issues in their own rural and community clinical IPE implementation efforts

A Spatial Analysis of Physician Assistant Programs

Purpose: The Accreditation Review Commission on Education for the Physician Assistant projects a total of 273 accredited programs by the summer of 2020. Over the past 10 years, the number of Central Application Service for Physician Assistants (CASPA) applicants per seat has increased by 53%. However, no studies have addressed the current geographic relationship of applicants to programs and program growth. The purpose of this study was to describe the geospatial patterns and relationships of physician assistant (PA) programs and CASPA applicants. Methods: Program directory information for established (n = 159), satellite (n = 18), and new PA programs (n = 95) was mapped using ArcGIS software. Permanent US ZIP codes for PA applicants (n = 22,603) from the 2014 to 2015 CASPA admissions cycle were also mapped. Point data were used to calculate the nearest neighbor by program type. Correlation was used to measure the association between PA applicants, program class size, and state population metrics. Results: Most of the 95 new PA programs were geographically close to established programs. The median distance of new programs to the nearest neighboring established program was 25.6 miles (mean 39, standard deviation 38). Both established and new PA programs were found to be highly clustered (Moran\u27s I z score \u3c 2.58, p = .01). The geographic distribution of the CASPA applicant pool was related to distribution of the US population, certified PAs, and practicing physicians. Conclusions: PA program growth has exceeded projections. The close proximity of new programs to established programs will likely result in continued competition for quality applicants, PA faculty members, and clinical training sites

How partnerships for community-based health professions training were affected by national changes in funding

Background: Area Health Education Centers (AHEC) have contributed to U.S. healthcare workforce training since 1971. National funders recently refocused efforts from K-12 students to matriculated health profession students, which reduced annual funding by $75,000 (25%) per year per Center. Objectives: To describe how community partnership changed due to funding reductions. Methods: Key informant interviews were conducted with all four regional center directors with community partnerships. Lessons learned: Hosted regional centers navigated partnerships in ways that did not significantly change programs because the host institutions supported continuing the partnerships. Independent centers experienced significant changes in partnerships by ending well-established programs and starting new programs with new partners. Both hosted and independent centers took salary cuts, downsized staff, and applied for grants and contracts to fill the funding gap. Improved communication with the Oregon AHEC program office was reported as needed. Conclusions: Navigating partnerships differed according to host status

Economic models for sustainable interprofessional education

Limited information exists on funding models for interprofessional education (IPE) course delivery, even though potential savings from IPE could be gained in healthcare delivery efficiencies and patient safety. Unanticipated economic barriers to implementing an IPE curriculum across programs and schools in University settings can stymie or even end movement toward collaboration and sustainable culture change. Clarity among stakeholders, including institutional leadership, faculty, and students, is necessary to avoid confusion about IPE tuition costs and funds flow, given that IPE involves multiple schools and programs sharing space, time, faculty, and tuition dollars. In this paper, we consider three funding models for IPE: (a) Centralized (b) Blended, and (c) Decentralized. The strengths and challenges associated with each of these models are discussed. Beginning such a discussion will move us toward understanding the return on investment of IPE

Rural Interprofessional Health Care Education: a Study of Student Perspectives

As the cost for health care delivery increases, so does the demand for access to care. However, individuals in a rural community often do not have access to the care they need. Shortages of rural health care professionals are an ever-increasing problem. The Affordable Care Act of 2010 sought to increase health care access by focusing on team-based care delivery. Thus, the need to educate health care students in the fundamentals of team-based practice has led to an increased emphasis on Interprofessional Education (IPE). While past research focused on urban IPE, a literature gap exists for the effects of a rural team-based educational experience on practice location decisions. This study examined how rural IPE influenced health profession students\u27 perspectives of what it means to be a member of a rural health care team and explored what factors go into making decisions of where to live and provide care. Motivational Theory provided the framework for a mixed methods approach with data from student reflective journaling and a post-experience Q sort. Analysis yielded important understandings about the impact of rural IPE. Accordingly, having a rural IPE experience provided positive motivation for returning after graduation. Further, the time spent in rural IPE generated understandings of what it means to live and provide care to a rural community. One important new discovery gained is the clinical setting is not where most IPE took place. As a result, social interactions with fellow students and community members achieved the goals of rural IPE. Despite these influential findings, noted barriers to genuine rural IPE persisted. In the end, students, educators, and rural health care professionals need to be aware of the multiple factors that guide decisions of where to live and provide care

What Works in Rural IPE? A Study of Student Reflections

Background: Team-based care has been proposed as a way to utilize rural healthcare resources wisely. Thus, the need to educate healthcare profession students in the fundamentals of rural team-based practice has increased in recent years. Thisstudy  sought to examine student reflections of a rural interprofessional practice and education (IPE) program in an effort to learn how students described their experience and what they valued.Methods and findings: Student reflection journals from a formal rural IPE program were examined for themes related to post-experience values, attitudes, and beliefs. In general, the time spent in rural IPE led to understanding what it means to live and provide care as a team to a rural community. One important new discovery is that social interactions outside formal IPE curriculum are central to achieving programmatic goals.Conclusion: Understanding the significance of rural IPE and how to guide students both inside and outside the clinical setting will help lead the development of future IPE. The findings of this study shed light on what students valued in a rural IPE experience and, thus, have implications for where institutional resources should be concentrated

Development of a Longitudinal Curricular Evaluation Framework for Intra- and Interprofessional Teamwork

Objectives: To describe the development and evaluation of a university-wide competency and evaluation framework for intra- and interprofessional education (IPE) teamwork.Methods: Development of the framework was based on existing literature and specific contexts of the schools within our university. Evaluation and program alignment regarding use of the framework were achieved through qualitative interviews with deans of the Schools of Medicine, Nursing, and Pharmacy, and focused on how they evaluated student progression towards the university-wide teamwork competency. Interview data were analyzed using classical content analysis.Results: Despite efforts to carefully design the framework, interviews revealed that significant variation exists regarding when and how both IPE and team-based care are taught and evaluated across schools. Common barriers to interprofessional education included variations in teamwork practices across disciplines, scheduling challenges, and lack of resources for implementation. Recommendations for how to align teaching and evaluation activities with the framework are posed.Conclusions: Longitudinally tracking the development of interprofessional competencies within/across health professions schools requires careful planning and collaboration among institutional leaders, interprofessional educators, program evaluators, and students. The information gained from this process provides insights toward implementing future high-quality IPE in teamwork and other inter- and intraprofessional competencies, which may be helpful to others