Figure 1 Staircase Model for Community Involvement in CO/BME
Wagdy Talaat 1, Mariam Asaad Amin 2
1MD, PhD, FHPE, Head of Medical Education Department, Faculty of Medicine Suez Canal university, Ismailia, Egypt
2MD, PhD, MHPE, Professor Anatomy Department, Faculty of Medicine Ain Shams University, Cairo, Egpyt
ABSTRACT
Problem: For institutions to successfully implement a community-oriented/based education strategy, it is necessary to have full support from the community. Without such support, there may not be sufficient foundation to train students within the community, or to orient curricula to address community health needs and priority problems. Building mutual trust between communities and academia takes time and effort. Some educators think it is easy to “enter” the community and send students for training. Approach: It is essential to approach this education strategy with compassion and empathy. Careful planning and adequate time allocation are crucial to engage communities at different levels. Communities are often apprehensive, but they can be highly responsive when treated with respect and their requests given consideration. To ensure a successful engagement with local communities, it is imperative to consider their perspective and tailor the engagement process to suit their unique needs and expectations. Failure to do so may result in negative consequences, which could jeopardize the success of the initiative. Outcomes: This article outlines a staircase model for medical schools to effectively engage their local community and progress towards achieving community partnership followed by weaning. The model is innovative and aligns with the social accountability principles set forth by the World Health Organization. Building a strong community–university partnership requires careful planning and implementation of various components. Next Steps: By considering all factors, we can build a sustainable, collaborative partnership that benefits both the community and the university with tremendous relief from the burden on the local government.
Keywords: Community involvement, community mobilization, community empowerment, community participation, community-university partnership, community oriented, based medical education
Date submitted: 9-May-2024
Email: Mariam Asaad Amin (mariamasaad@med.asu.edu.eg)
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Citation: Talaat W, Amin M. SStaircase model for community involvement in community-oriented/based medical education: Steps to achieve CO/CBME. Educ Health 2024;37: 265-269
Online access: www.educationforhealthjournal.org
DOI: 10.62694/efh.2024.84
Published by The Network: Towards Unity for Health
Community involvement in health development emerged with a re-invigorated approach in the last two decades of the 20th century. This approach aimed to bridge the gap between the formal, professional health structure and local people by collaboratively harnessing expertise and capabilities.1 Establishing community-based education institutions is a challenging task, especially when considering the need to develop a strong and enduring relationship with the local community where the school will send its students for a significant portion of their education.2 However, this is a necessary step that has been taken by many educational institutions, even before the World Health Organization (WHO) introduced the concept of sociably accountable medical schools.2 The process of “entering” the community is far from straightforward as the local communities often have a deep-seated mistrust of academia due to previous negative experiences.2 Many schools have spent years refining their approach through trial and error to involving the local community in Community-Based Learning Activities (CBLA) and health development.3 Therefore, finding the right key to unlocking a successful relationship with the community can be elusive—a mystery that perplexes medical school administration, faculty, and students alike.3
The effective and positive participation of local communities in health development is crucial to alleviate the burden on local governments, particularly in developing and underdeveloped countries.4 In such regions, health services are often centralized in capitals and major cities, resulting in inequitable distribution and neglect of remote local communities.4 Consequently, such communities are left to fend for themselves and seek assistance from agencies that can support their self-reliant efforts. It is imperative to address this issue to ensure equitable access to healthcare and promote overall health development.5 In such a context, institutions specializing in health professions education, and promoting community-based approaches, would be best suited to play a socially accountable role within their local communities while integrating this responsibility into their core mission.
In a previous publication, we shared a narrative that detailed the challenges faced, accomplishments achieved, and lessons learned, based on the experiences of a leading medical school, the Faculty of Medicine at Suez Canal University, Egypt. This narrative explored the Faculty’s experience in CBME that is oriented towards community health needs and priority health problems.2
It is crucial for universities, particularly community-oriented medical colleges that aim to transform the local community into a training ground for students and faculty, to focus on building trust between the community and the university. This requires identifying and engaging with the informal leaders of the community, as formal leaders are often influenced by politics and personal interests rather than the actual needs of their local communities. Universities must work towards comprehensive collaboration that prioritizes the needs of the local community to successfully train their students and faculty in an inter-professional education environment in order to make a positive impact in the community.6
According to the WHO definition, community diagnosis is “a quantitative and qualitative description of the health of citizens and the factors which influence their health. It identifies problems, proposes areas for improvement, and stimulates action.”7 Community diagnosis is a crucial part of CBME that should be performed regularly. It helps in many ways by providing important information for the local area and the people living there, and identifying areas that need attention and suggesting practical solutions. It also helps to decide where resources should be focused and what kind of work should be done. In addition, community diagnosis encourages people from different areas to work together and learn from each other, and sets up ways to measure progress and keep improving.8
Community mobilization is a means of engaging community members in identifying and addressing social issues. It involves activating a group of people who may be inactive or ineffective and guiding them towards effective action on issues that matter to them. It’s important to note that community mobilization isn’t an end in itself—it’s a tool to reach a desired outcome. 2
The process of mobilization follows sequential steps that entail interconnecting the awareness of a problem’s causes, consequences, and costs, with a call to action that enables the community to take steps towards remedying the problem, or preventing it from reoccurring. This approach facilitates change by fostering a sense of responsibility among community members to initiate and sustain the change process.9
Prior to successful stimulation of any community development, there are certain prerequisites that must be met, such as ensuring that the development process is well-informed, strategic, and responsive to the needs and context of the community. This could be done through identifying and then addressing community problems, and encouraging members to work together to advocate for the aspired change. It is imperative to invest time and resources in assessing and planning these prerequisites before embarking on community development initiatives.10
This step involves assessing the current situation using mixed method approaches. Useful data to be collected include demographic, infrastructure, educational and social facilities as well as cultural resources.11 Simultaneously, this should be done by involving the right people, like health professionals and community leaders, appointing a strong and passionate leader, setting clear goals and strategies, and identifying potential funding sources.11
A community impact statement outlining the initiative’s goals and strategies can be formulated in various formats, including press releases, letters, and TV media. This serves as a valuable tool for raising awareness and further engaging with the community.2
When individuals unite around a common vision, they can work collaboratively to create shared benefits that contribute to the greater good. The key to sustaining momentum for mobilization lies in the ability of all concerned parties to drive ongoing engagement and participation over time. By fostering a sense of collective responsibility and collaboration, mobilization efforts can yield significant outcomes that benefit both individuals and the broader community.12
Creating a strategic plan that addresses the community’s needs will include specific steps, a timeline, and list all necessary resources. Community leaders, together with academic professionals, can delegate responsibilities fairly among coalition members, identifying and preparing additional materials for use, and implementing actions aimed at key target audiences. This in turn ensures that local communities are in the driver’s seat of their process of change.9
With any community mobilization effort, it is important to keep track of activities that are most effective in the community and those that may need to be improved upon to more successfully meet planned goals.10
Community mobilization/empowerment efforts in developing countries have been hindered by high rates of illiteracy.2 To overcome this challenge, functional literacy programs have been developed to target the local community and serve as the foundation for community empowerment initiatives.2 These programs aim to increase literacy rates and provide individuals with the necessary skills to participate in and contribute to their communities, ultimately promoting sustainable development.2
One effective way to promote sustainability is by encouraging functional participation. This means that community leaders/managers need to put in back-end work to inspire the community to take the initiative. By promoting interactive participation, individuals are empowered to make decisions that positively impact their community.12
It is important for communities to strive towards achieving the ideal of self-mobilization. With a little planning and support, any community can start out on the path towards self-mobilization. While it may be more challenging for historically under-resourced communities, their leaders and change agents should focus on the top three forms of involvement: functional participation, interactive participation, and self-mobilization, so as to activate their community and achieve their goals.2
Voluntary collaboration between academia and the community is established to achieve the agreed upon goals. This collaboration is in the form of:
Empowering communities can be a powerful catalyst for their independent growth and development. By working collaboratively, developmental programs and NGOs can help to create sustainable change. The maturity of the community can be seen in moving towards being self-reliant, planning and implementing their own projects, as well as seeking academic partnership by themselves.2 The academic staff can also play a pivotal role in this process by monitoring, advising, investigating, documenting, and initiating similar projects in other regions.8 The thoughts and suggestions from community members about how to improve community health should be shared with everyone in the community, and with government officials who have the power to make decisions. This will allow them to negotiate for necessary resources needed to implement the ideas.8
Facilitating connections between students and their community provides opportunities for personal development and further contribution. Engaging in projects that benefit society can instill a sense of fulfillment and contentment. Working collaboratively in inclusive environments also allows students to acquire new skills or refine existing ones, while bolstering their self-assurance.6
In this article, we present an innovative staircase model consisting of six levels (Fig. 1), which outlines the various levels and methods of community involvement and Community-Based Learning Activities (CBLA) that are part of Community-Based Medical Education (CBME).
Figure 1 Staircase Model for Community Involvement in CO/BME
This staircase moves up from the initial stages of building trust to the ultimate goal of achieving sustainability.
Medical institutions that aim to implement a community-oriented/based education strategy must receive a positive response from the community to establish a strong foundation for student training and effectively address priority health problems. Engaging the community as a partner in advancing health professions education, particularly in community-oriented/based education, is a complex endeavor that requires careful consideration and effort. We should not underestimate the importance of this vital collaboration.
Approaching the community and building up a healthy and sustainable relationship up to the level of full partnership with the university and local government needs a political will from the health professions education institution’s administration, and goes through certain ascending steps to avoid undesirable setbacks. In this article, we explained such gradual steps in a creative innovative model that we called, “Staircase model for community involvement in Community-Oriented/Based Education”. Within this model, community leaders play a significant role in establishing and maintaining long-standing relationships. The proposed model has the potential to establish reliable relationships between various institutions and their communities, which can benefit the health professions education sector on a global scale.
Not applicable
Not applicable
The data supporting the findings of this study are available from the internet and websites of the cited references. Data are available from the corresponding author on reasonable request via email.
Authors herby declare that no funding was received for conducting this study.
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